Struct Heart. 2026 Jul 23;10(9):101100. doi: 10.1016/j.shj.2026.101100. eCollection 2026 Sep.
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.
RESULTS: Overall, 71 studies involving 481,353 patients were included. Compared with males, females demonstrated a higher short-term risk of adverse outcomes, including 30-day all-cause mortality (hazard ratio [HR]: 1.064, 95% CI: 1.005-1.127; p = 0.033) and stroke/transient ischemic attack (HR: 1.511, 95% CI: 1.317-1.734; p < 0.001). Females were also more likely to experience life-threatening bleeding (risk ratio [RR]: 1.29, 95% CI: 1.03-1.62; p = 0.028), major bleeding (RR: 1.26, 95% CI: 1.13-1.41; p < 0.001), and major vascular complications (RR: 1.66, 95% CI: 1.53-1.81; p < 0.001). Despite these higher periprocedural risks, females demonstrated superior long-term outcomes, with lower all-cause mortality (HR: 0.812, 95% CI: 0.794-0.831; p < 0.001) and cardiovascular mortality (HR: 0.837, 95% CI: 0.784-0.893; p < 0.001) during follow-up extending to 10 years, whereas risks of stroke/transient ischemic attack and myocardial infarction were comparable between sexes.
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.
PMID:42701677 | PMC:PMC13545726 | DOI:10.1016/j.shj.2026.101100