{"id":"7d7519527093","type":"article","url":"https://hartvaat.nl/2026/01/16/sekseverschillen-na-tavi-vrouwen-lagere-sterfte-bij-intermediair-risico-maar-mee/","title":"Sekseverschillen na TAVI: vrouwen lagere sterfte bij intermediair risico, maar meer bloedingen","title_en":"Sex-based differences in outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis of randomised trials","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["aortainsufficiëntie","aortastenose","perifeer-vaatlijden"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003642?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003642?rss=1","authors":["Ferraz-Costa","G. N.","Almeida","M. d. J.","Delgado Silva","J.","Goncalves","L."],"significance":6,"published":"2026-01-16","source_date":"2026-01-16","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/kleplijden/tavi-transcatheter-aortaklepimplantatie/"],"congress":"","summary_en":"In surgical aortic valve replacement, female sex has historically been associated with worse outcomes, but for transcatheter aortic valve implantation (TAVI) the evidence is unclear — even as women are more often referred for TAVI. This systematic review and meta-analysis of randomised trials (14 RCTs, 15,225 participants) compared outcomes between women and men. There was no overall difference in all-cause mortality (OR 0.83), but a protective effect for women among intermediate-risk patients (OR 0.64). Women had a higher risk of major bleeding (OR 1.35). Cardiovascular mortality, stroke/TIA and pacemaker implantation did not differ. Female sex was thus associated with lower mortality in intermediate-risk TAVI but more bleeding — warranting further study of anatomical and procedural sex differences.","created":"2026-07-03T10:32:27Z","updated":"2026-07-03T13:31:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Bij chirurgische aortaklepvervanging is het vrouwelijke geslacht historisch geassocieerd met slechtere uitkomsten, maar voor transkatheter-aortaklepimplantatie (TAVI) is het bewijs onduidelijk — terwijl vrouwen juist vaker voor TAVI worden verwezen. Deze systematische review en meta-analyse van gerandomiseerde trials (14 RCT's, 15.225 deelnemers) vergeleek de uitkomsten tussen vrouwen en mannen. Er was geen algemeen verschil in totale sterfte (OR 0,83), maar wel een beschermend effect voor vrouwen bij patiënten met een intermediair risico (OR 0,64). Vrouwen hadden een hoger risico op majeure bloedingen (OR 1,35). Cardiovasculaire sterfte, beroerte/TIA en pacemakerimplantatie verschilden niet. Het vrouwelijke geslacht ging dus gepaard met een lagere sterfte bij intermediair-risico-TAVI, maar met meer bloedingen — wat verder onderzoek naar anatomische en procedurele sekseverschillen rechtvaardigt.","abstract_original":"<sec><st>Background</st>\n<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>\n</sec>\n<sec><st>Objectives</st>\n<p>To systematically evaluate and summarise randomised clinical trial (RCT) evidence comparing TAVI outcomes between women and men.</p>\n</sec>\n<sec><st>Methods</st>\n<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>\n</sec>\n<sec><st>Results</st>\n<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>\n</sec>\n<sec><st>Conclusion</st>\n<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>\n</sec>\n<sec><st>PROSPERO registration number</st>\n<p>CRD42024510202.</p>\n</sec>"}