{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:14:38Z","timestamp":1792512878771,"version":"4.5.0"},"reference-count":38,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,11,8]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To systematically evaluate and summarise randomised clinical trial (RCT) evidence comparing TAVI outcomes between women and men.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>14 RCTs with a total of 15\u2009225 participants were included. No overall difference in all-cause mortality was observed between sexes (OR: 0.83; 95%\u2009CI 0.65 to 1.06), though a significant protective effect for female sex was found among intermediate-risk patients (OR: 0.64; 95%\u2009CI 0.49 to 0.84; I\u00b2=0%). Women had a significantly higher risk of major bleeding (OR: 1.35; 95%\u2009CI 1.21 to 1.52; I\u00b2=15%). No significant sex-based differences were identified in cardiovascular mortality (OR: 0.98), stroke\/TIA (OR: 0.96) or PPI (OR: 1.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42024510202.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003642","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T19:10:45Z","timestamp":1768590645000},"page":"e003642","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Sex-based differences in outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis of randomised trials"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6510-3690","authenticated-orcid":false,"given":"Gon\u00e7alo Nuno","family":"Ferraz-Costa","sequence":"first","affiliation":[{"name":"ULS Coimbra, Coimbra, Coimbra District, Portugal"},{"name":"University of Coimbra Institute for Clinical and Biomedical Research, Coimbra, Coimbra District, Portugal"},{"name":"Faculty of Medicine, Universidade de Coimbra Faculdade de Medicina, Coimbra, Coimbra District, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana de Jesus","family":"Almeida","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universidade de Coimbra Faculdade de Medicina, Coimbra, Coimbra District, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Delgado Silva","sequence":"additional","affiliation":[{"name":"ULS Coimbra, Coimbra, Coimbra District, Portugal"},{"name":"University of Coimbra Institute for Clinical and Biomedical Research, Coimbra, Coimbra District, Portugal"},{"name":"Faculty of Medicine, Universidade de Coimbra Faculdade de Medicina, Coimbra, Coimbra District, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lino","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"ULS Coimbra, Coimbra, Coimbra District, Portugal"},{"name":"University of Coimbra Institute for Clinical and Biomedical Research, Coimbra, Coimbra District, Portugal"},{"name":"Faculty of Medicine, Universidade de Coimbra Faculdade de Medicina, Coimbra, Coimbra District, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"2026011611103048000_13.1.e003642.1","doi-asserted-by":"crossref","first-page":"16006","DOI":"10.1038\/nrdp.2016.6","article-title":"Calcific aortic stenosis","volume":"2","author":"Lindman","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"2026011611103048000_13.1.e003642.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1008232"},{"key":"2026011611103048000_13.1.e003642.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1103510"},{"key":"2026011611103048000_13.1.e003642.4","doi-asserted-by":"crossref","unstructured":"Praz F , Borger MA , Lanz J , et al . 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