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Updated: Jun 11, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Sex-Specific and Time-Dependent Outcomes After TAVR Versus SAVR: A Meta-Analysis of Randomized Trials
Hendrianus Hendrianus1, Jun Hwan Cho2, Hoyoun Won3
1Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea; Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea; Division of Cardiology, Natuna General Hospital, Natuna, Indonesia.
Transcatheter aortic valve replacement (TAVR) showed early benefits for women, especially intermediate-high-risk patients, compared to surgical aortic valve replacement (SAVR). Outcomes converged over time, with men showing no significant differences but higher TAVR risk at 5 years.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Sex differences in outcomes after transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) are known, but temporal trends and risk stratification remain unclear.
- Understanding these variations is crucial for optimizing patient selection and treatment strategies.
Purpose of the Study:
- To evaluate sex-specific and time-dependent outcomes of TAVR compared to SAVR.
- To assess the influence of baseline surgical risk on these sex-specific outcomes.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using PubMed, Embase, and Cochrane Central Register of Controlled Trials up to January 2026.
- Included RCTs reported sex-stratified, mortality-inclusive primary endpoints with at least one-year follow-up.
- Pooled risk ratios (RRs) were calculated using random-effects models, with analyses stratified by sex and surgical risk.
Main Results:
- Nine RCTs comprising 9,583 patients (44.2% women) were analyzed.
- In women, TAVR demonstrated lower risk at 1 and 2 years compared to SAVR (1-year RR: 0.67; 2-year RR: 0.80), with no significant difference at 5 years.
- In men, no significant differences in outcomes were observed across time points. Early TAVR benefit in women was more pronounced in intermediate-high-risk patients, while at 5 years, TAVR showed higher risk in men within this group.
Conclusions:
- Aortic valve replacement outcomes are influenced by sex, surgical risk, and time.
- TAVR offers an early survival advantage for women, particularly those at intermediate-high surgical risk, with outcomes converging with SAVR over longer follow-up.
- Men did not exhibit significant time-dependent outcome differences, but intermediate-high-risk men faced increased risk with TAVR at the 5-year mark.
