TAVR outcomes differ by sex and vary over time, with women seeing an early benefit with TAVR vs. SAVR that converged by year five and men exhibiting no significant differences across time points, according to a meta-analysis of nine randomized trials published June 10 in JACC: Advances. Early differences were more apparent in intermediate-high-risk patients, particularly in women, while the authors noted higher risk with TAVR in intermediate-high-risk men at five years.

Hendrianus Hendrianus, MD, FACC, et al., explored sex-specific and time-dependent outcomes of TAVR vs. SAVR, including 9,583 patients (44% women) from nine randomized controlled trials. Their analysis also considered the influence of baseline surgical risk. The study's primary outcome was the trial-defined endpoint - all of which included mortality as a component.

Among women, TAVR had a lower risk at years one and two vs. SAVR (one year: risk ratio [RR], 0.67; 95% CI, 0.55-0.81; two years: RR, 0.80; 95% CI, 0.69-0.94). By year five, there was no significant difference in risk between transcatheter and surgical intervention (RR, 1.03; 95% CI, 0.89-1.18). No significant differences in risk were identified in men across time points.

Early benefit with TAVR in women was more pronounced in intermediate-high-risk patients, and men considered intermediate-high risk who underwent TAVR suffered a higher risk at year five. In contrast, the authors found that "in lower-risk populations, where procedural risk is reduced and life expectancy is longer, outcomes between TAVR and SAVR were broadly similar across sexes over time."

"These findings do not support a sex-based treatment mandate but instead reinforce the need for shared decision-making that integrates patient sex, surgical risk, anatomical characteristics, comorbidity burden, life expectancy and patient preferences," they write.