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Updated: May 7, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Sex-related differences in outcomes after transcatheter aortic valve implantation: a systematic review and
Zhen-Gang Zhao1, Yan-Biao Liao, Yong Peng
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China.
Insights
Men experience different outcomes after transcatheter aortic valve implantation (TAVI). While men have fewer bleeding and vascular complications, they face higher mortality risks, indicating less favorable survival rates post-TAVI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Significant discrepancies exist regarding sex-based differences in complications and prognosis following transcatheter aortic valve implantation (TAVI).
- Understanding these sex-related variations is crucial for optimizing TAVI patient care and outcomes.
Purpose of the Study:
- To systematically review and meta-analyze existing literature on sex-specific complications and mortality after TAVI.
- To identify and quantify significant sex-related differences in early and midterm outcomes following TAVI.
Main Methods:
- A systematic search of the Cochrane Library and PubMed databases was conducted.
- Twenty-seven studies involving 9118 patients (4176 men, 4942 women) were included in the meta-analysis.
- Random- and fixed-effects models were employed to pool data on complications and mortality.
Main Results:
- Men had significantly lower risks for major/life-threatening bleeding (RR 0.81) and major vascular complications (RR 0.49).
- However, male sex was associated with significantly higher risks of death at 30 days (RR 1.37) and 1 year (RR 1.30).
- A significant difference in heart block requiring permanent pacemaker was observed only in CoreValve studies (RR 1.29).
Conclusions:
- Despite lower risks of bleeding and vascular complications, men exhibit less favorable short-term and midterm survival after TAVI.
- These findings highlight important sex-based prognostic differences in TAVI patients that warrant clinical attention.
Background:
There were considerable discrepancies with regard to sex-related differences in complications and prognosis after transcatheter aortic valve implantation.
Methods And Results:
The Cochrane library and PubMed online databases were searched. Articles reporting sex-specific post-transcatheter aortic valve implantation complications and mortality were identified. Two authors selected studies and extracted data independently. Random- and fixed-effects models were used depending on between-study heterogeneity. There were 27 articles, a total of 9118 patients, enrolled in our systematic review and meta-analysis, including 4176 men and 4942 women. Pooled analyses suggested considerable sex-related differences in complications and early as well as midterm outcomes after transcatheter aortic valve implantation. The difference in the risk for heart block requiring permanent pacemaker implantation was noted to be significant only in the subgroup of the CoreValve-dominating studies (pooled risk ratio [RR, men versus women], 1.29; 95% confidence interval [CI], 1.13-1.47). Although men had significantly lower risks for major/life-threatening bleeding (pooled RR, 0.81; 95% CI, 0.68-0.96) and major vascular complications (pooled RR, 0.49; 95% CI, 0.37-0.66), they had poorer prognosis. In fact, male sex was associated with significantly higher risks for deaths at both 30 days (RR, 1.37; 95% CI, 1.07-1.76) and 1 year (RR, 1.30; 95% CI, 1.14-1.49).
Conclusions:
Although men had lower risks for major/life-threatening bleeding and major vascular complications after transcatheter aortic valve implantation, they had less favorable short-term and midterm survival.