Sekseverschillen na TAVI: vrouwen lagere sterfte bij intermediair risico, maar meer bloedingen

<sec><st>Background</st> <p>While female sex has historically been associated with worse outcomes following surgical aortic valve replacement, the evidence regarding sex-related differences after transcatheter aortic valve implantation (TAVI) remains inconclusive. Given that women are more frequently referred for TAVI, clarifying the role of sex in procedural outcomes is clinically relevant.</p> </sec> <sec><st>Objectives</st> <p>To systematically evaluate and summarise randomised clinical trial (RCT) evidence comparing TAVI outcomes between women and men.</p> </sec> <sec><st>Methods</st> <p>A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42024510202). PubMed, EMBASE and Web of Science were searched for English-language RCTs up to 1 July 2024. Studies comparing TAVI outcomes by sex were included. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, stroke or transient ischaemic attack (TIA), major bleeding and permanent pacemaker implantation (PPI). Pooled ORs were calculated using Mantel-Haenszel random-effects models.</p> </sec> <sec><st>Results</st> <p>14 RCTs with a total of 15 225 participants were included. No overall difference in all-cause mortality was observed between sexes (OR: 0.83; 95% CI 0.65 to 1.06), though a significant protective effect for female sex was found among intermediate-risk patients (OR: 0.64; 95% CI 0.49 to 0.84; I&sup2;=0%). Women had a significantly higher risk of major bleeding (OR: 1.35; 95% CI 1.21 to 1.52; I&sup2;=15%). No significant sex-based differences were identified in cardiovascular mortality (OR: 0.98), stroke/TIA (OR: 0.96) or PPI (OR: 1.05).</p> </sec> <sec><st>Conclusion</st> <p>Female sex was associated with a lower all-cause mortality among intermediate-risk patients undergoing TAVI, but also with a higher overall risk of major bleeding. These findings suggest the need for further investigation into sex-related anatomical and procedural factors.</p> </sec> <sec><st>PROSPERO registration number</st> <p>CRD42024510202.</p> </sec>