Sex-Specific Differences in Clinical Outcomes After Transcatheter Aortic Valve Replacement: A Meta-Analysis of Reconstructed Individual Patient Survival Data

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Severe aortic stenosis undergoing TAVR (n=481353). Intervention: Female sex vs. Male sex. Primary outcome: All-cause mortality at up to 10 years (HR 0.812, 95% CI 0.794-0.831, p=<0.001).

Q: What does this research mean for the field?

Females undergoing transcatheter aortic valve replacement experience higher early risks of complications but exhibit a sustained long-term survival advantage over males extending to 10 years. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ali Abdelaziz; Mohamedhen Vall Nounou; Ahmad M Al Othman; Mirvat Alasnag; Alaide Chieffo; J. Dawn Abbott; Abubaker Al-Allawee; Sofian Zreigh; Mohammed Benhammou; Muhiddin Dervis; Walid Guerguer; Ashraf Haidarah; Rafeek Elmezayen; Mohammad Alzu’bi; Serag Almzainy; Saber Khalid; Qasim Shawesh; Maram Abuajamieh; Muhammed Elhadi; R Bagur; M A Mamas

doi:10.1016/j.shj.2026.101100

Figures

Graphical abstract published by Structural Heart — Graphical abstract · Published by Structural Heart · CC BY

Why the study?

Females with severe aortic stenosis present with distinct anatomical and clinical characteristics compared to males, which may influence outcomes after TAVR.

Does female sex influence short- and long-term clinical outcomes in patients undergoing transcatheter aortic valve replacement compared to males?

Key Points

To investigate the prognostic impact of sex-specific differences on short- and long-term outcomes following transcatheter aortic valve replacement (TAVR).
Searched PubMed, Embase, Scopus, and Web of Science through August 2025 for randomized and observational studies evaluating sex-specific outcomes post-TAVR.
Females showed a higher 30-day risk of all-cause mortality (HR: 1.064, 95% CI: 1.005 to 1.127; p = 0.033) and early stroke/TIA (HR: 1.511, 95% CI: 1.317 to 1.734; p < 0.001) compared with males.
Over long-term follow-up extending to 10 years, females achieved significantly better all-cause survival (HR: 0.812, 95% CI: 0.794 to 0.831; p < 0.001) and cardiovascular survival (HR: 0.837, 95% CI: 0.784 to 0.893; p < 0.001).
Cumulative 10-year stroke/TIA risk was comparable between sexes (HR: 1.037, 95% CI: 0.967 to 1.111; p = 0.30).

Study Design

Type

Meta-Analysis (n=481,353)

Multicenter

Yes

Structured PICO

Does female sex influence short- and long-term clinical outcomes in patients undergoing transcatheter aortic valve replacement compared to males?

P

Population

481,353 patients with severe aortic stenosis undergoing TAVR across 71 studies, with 49.6% females, followed for up to 10 years.

E

Exposure

Female sex (female patients undergoing TAVR)

C

Comparator

Male sex (male patients undergoing TAVR)

O

Outcome

All-cause and cardiovascular mortalityhard clinical

Main Result

Hazard Ratio: 0.812 (95% CI 0.794–0.831)

p-value: p=<0.001

Females undergoing TAVR face higher early procedural risks including bleeding and vascular complications, but exhibit a significant and sustained long-term survival advantage compared to males.

Limitations

Most included studies were observational and retrospective, introducing potential residual confounding and selection bias
Reconstructed IPD does not provide complete individual-level covariate structure required for propensity-based adjustment
Heterogeneous frailty assessment tools precluded quantitative pooling
Outcome definitions evolved with changes in VARC criteria and valve-generation technology
Cardiovascular mortality analyses did not account for competing noncardiovascular deaths
Multiple secondary and subgroup analyses were performed without adjustment for multiple comparisons
Reconstructed IPD recover event times but not individual-level baseline covariates, yielding unadjusted sex-specific estimates
Reliance on censoring-time estimation for some KM curves lacking risk tables
Heterogeneous frailty indices prevented quantitative pooling
Small number of contributing KM data sets and variable follow-up for secondary endpoints like rehospitalization and MI

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Implication

Higher early post-TAVR risks in females warrant procedural caution; extends evidence of long-term survival benefit to 10 years.

Abstract

Background: Females with severe aortic stenosis present with distinct anatomical and clinical characteristics compared to males, which may influence outcomes following transcatheter aortic valve replacement (TAVR). We sought to investigate the prognostic impact of sex-specific differences on short- and long-term outcomes following TAVR. Methods: PubMed, Embase, Scopus, and Web of Science were searched through August 2025 for randomized and observational studies reporting sex-specific outcomes after TAVR. Reconstructed individual patient data from published Kaplan-Meier (KM) curves were used to estimate long-term survival outcomes. Conclusions: Females undergoing TAVR experience higher early risks of mortality, stroke, bleeding, and vascular complications, but exhibit a sustained long-term survival advantage compared with males, highlighting the need for sex-centered periprocedural management strategies.

Discussion

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Cite This Study

Abdelaziz et al. (2026) conducted a meta-analysis in Severe aortic stenosis undergoing TAVR (n=481,353). Female sex vs. Male sex was evaluated on All-cause mortality at up to 10 years (HR 0.812, 95% CI 0.794-0.831, p=<0.001).

synapsesocial.com/papers/6aa377bbdd5797a3831a9fc0 https://doi.org/10.1016/j.shj.2026.101100

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Sex-Specific Differences in Clinical Outcomes After Transcatheter Aortic Valve Replacement: A Meta-Analysis of Reconstructed Individual Patient Survival Data

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sex-Specific Differences in Clinical Outcomes After Transcatheter Aortic Valve Replacement: A Meta-Analysis of Reconstructed Individual Patient Survival Data

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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