Sex-related differences in survival and safety outcomes after transcatheter aortic valve replacement: a meta-analysis of reconstructed time-to-event data

Tavakoli, K; Hosseini Mohammadi, NS; Fallahtafti, P; Khamene, SS; Taheri, M; Ebrahimi, P; Bahiraie, P; Karimi, E; Alishahi, MM; Pazoki, M; Anaraki, N; Kazemian, S; Khanipour, R; Khalique, OK; May, HT; Thachil, R; Iskander, MH; Waheed, A; Hosseini, K

doi:10.1093/ehjqcco/qcaf022

Valvular & structural heart disease

Sex-related differences in survival and safety outcomes after transcatheter aortic valve replacement: a meta-analysis of reconstructed time-to-event data

Eur Heart J Qual Care Clin OutcomesPublished 22 Apr 2025meta-analysis of reconstructed time-to-event data

Pooled result · All-cause mortalityResultHazard ratio 1.24 95% CI 1.20–1.28

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Authors' conclusion

Men demonstrated poorer 5-year overall survival and 4-year cardiovascular survival following TAVR compared with women. Future research with extended follow-up is needed to understand the mechanism underlying sex-specific TAVR outcomes.

Study context

Population: Patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR)48 studies
Participants: 65,580 vs 69,355

Comparison: Men compared with women
Menn = 65,580
Womenn = 69,355reference
Outcome: All-cause mortality
Follow-up: 5 years

Methodological detailsrandom-effects model, Individual patient data (IPD) were reconstructed from published Kaplan-Meier curves

Random-effects model
Individual patient data (IPD) were reconstructed from published Kaplan-Meier curves

Pooled result

As reported in the abstract

Hazard ratio

1.24

95% CI 1.20–1.28

P < 0.001

Menvs women

HR 1.24 (95% CI 1.20–1.28); P < 0.001

Further pooled results

Outcome	← Lower risk with men ←→ Higher risk with men →	HR (95% CI)	P value
Cardiovascular mortality · 4 yearsReconstructed IPD; higher risk in men	0.512	1.34 (1.21–1.49)	P < 0.001
	0.512Hazard ratio (log scale)

Safety

Outcome	← Lower risk with men ←→ Higher risk with men →	RR (95% CI)	P value
Permanent pacemaker implantation · during the first yearHigher risk in men · random-effects meta-analysis	0.512	1.29 (1.16–1.44)	P < 0.001
Stroke · 30 daysLower risk in men	0.512	0.75 (0.64–0.87)	P < 0.001
Major vascular complications · 30 daysLower risk in men	0.512	0.58 (0.49–0.69)	P < 0.001
Major bleeding · within the first yearLower risk in men	0.512	0.77 (0.70–0.84)	P < 0.001
Major vascular complications · within the first yearLower risk in men	0.512	0.54 (0.43–0.68)	P < 0.001
	0.512Relative risk (log scale)

Original publication

Sex-related differences in survival and safety outcomes after transcatheter aortic valve replacement: a meta-analysis of reconstructed time-to-event data. Eur Heart J Qual Care Clin Outcomes. Published 22 April 2025. doi:10.1093/ehjqcco/qcaf022

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