Sex differences in the outcomes after transcatheter aortic valve replacement with newer generation devices: A meta-analysis.

ABSTRACT

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a reasonable therapeutic approach among patients with symptomatic severe aortic stenosis irrespective of surgical risk. Data regarding sex-specific differences in the outcomes with newer generation valves are limited. METHODS: Electronic databases were searched for studies assessing sex differences in the outcomes of patients undergoing TAVR with newer generation valves (SAPIEN 3 or Evolut). Random effects model was constructed for summary estimates. RESULTS: Four observational studies with 4522 patients (44.8% women) were included in the meta-analysis. Women were older and had a lower prevalence of coronary artery disease and mean EuroScore. Women had a higher incidence of short-term mortality (up to 30 days) (risk ratio [RR] 1.60, 95% confidence interval [CI] 1.14-2.25), but no difference in 1-year mortality (RR 0.92, 95% CI 0.72-1.17). There was no significant difference in the incidence of major bleeding (RR 1.16, 95% CI 0.86-1.57), permanent pacemaker (PPM) (RR 0.80, 95% CI 0.62-1.04), or disabling stroke (RR 1.16, 95% CI 0.54-2.45). CONCLUSION: In this meta-analysis, we found that women undergoing TAVR with newer-generation devices were older but had a lower prevalence of comorbidities. Women had a higher incidence of short-term mortality but no difference in the 1-year mortality, bleeding, PPM, or stroke compared with men. Future studies are required to confirm these findings.