Sex-Specific and Time-Dependent Outcomes After TAVR Versus SAVR

BACKGROUND: Sex differences in outcomes after transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) have been reported, but their variation over time and across surgical risk strata remains uncertain. OBJECTIVES: The objective of the study was to evaluate sex-specific and time-dependent outcomes of TAVR vs SAVR and the influence of baseline surgical risk. METHODS: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched through January 18, 2026. Randomized controlled trials reporting sex-stratified, mortality-inclusive primary endpoints with ≥1-year follow-up were included. Pooled risk ratios (RRs) were estimated using random-effects models, with prespecified analyses by sex and surgical risk and exploratory meta-regression. RESULTS: Nine trials (N = 9,583; 44.2% women) were included. In women, TAVR was associated with lower risk at 1 and 2 years vs SAVR (1 year: RR: 0.67; 95% CI: 0.55-0.81; 2 years: RR: 0.80; 95% CI: 0.69-0.94), with no significant difference at 5 years (RR: 1.03; 95% CI: 0.89-1.18). In men, no significant differences were observed across time points. By surgical risk, early benefit with TAVR in women was more evident in intermediate-high-risk patients, whereas at 5 years a higher risk with TAVR was observed in men; no clear sex differences were seen in low-risk patients. Meta-regression showed no significant effect modification by age, surgical risk, or atrial fibrillation prevalence. CONCLUSIONS: Outcomes after aortic valve replacement vary by sex, surgical risk, and time. TAVR was associated with early benefit in women, particularly in intermediate-high-risk patients, with convergence over longer follow-up, whereas men showed no significant differences across time points, with higher risk observed with TAVR at 5 years in intermediate-high-risk patients. (Sex Differences in Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement: An Updated Meta-Analysis of Randomized Controlled Trials; CRD420261287967).