ABSTRACT NUMBER: ESOC2026A1558 SEX-SPECIFIC DIFFERENCES IN STROKE INCIDENCE AFTER TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT: A META-ANALYSIS

Abstract Background and aims Stroke remains a major complication following aortic valve replacement, yet sex-specific differences in stroke incidence and mortality after transcatheter versus surgical approaches are not well established. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) of patients with severe aortic stenosis undergoing TAVR or SAVR. We searched PubMed, Scopus, CENTRAL, and Web of Science from inception to December 2025. Outcomes were analyzed in women and men, with sex-specific pooling performed for stroke and all-cause mortality. Effect estimates were reported as risk ratios (RRs) with 95% confidence intervals (CIs). Results Stroke data were available for 2,401 women from five randomized trials and 2,519 men from four trials. In women, stroke incidence did not differ significantly between TAVR and SAVR (4.4% vs. 5.4%; OR = 0.73, 95% CI: 0.50–1.09). TAVR was associated with a significant reduction in all-cause mortality or disabling stroke compared with SAVR (OR = 0.73, 95% CI: 0.56–0.96), driven primarily by benefit in high surgical risk women (OR = 0.64, 95% CI: 0.42–0.98), while outcomes were comparable in low- or intermediate-risk women. In men, stroke incidence was similarly comparable between TAVR and SAVR across all surgical risk categories, with stroke rates of 5.2% and 6.6%, respectively (OR = 0.75, 95% CI: 0.53–1.04). Conclusions TAVR reduced death or disabling stroke in high-risk women, with no similar benefit observed in men. Conflict of interest None Figure 1 - belongs to Methods Figure 2 - belongs to Results