Influence of Gender on Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Background: To assess whether there are differences in common postoperative complications and survival between men and women after transcatheter aortic valve implantation.

Methods: We searched the Cochrane Library, PubMed, Embase, and the Web of Science from January 2000 to August 2022. Gender-related articles reporting complications and mortality after transcatheter aortic valve implantation were identified. The primary outcomes were the thirty-day mortality, one-year mortality and perivalvular leakage. The secondary outcomes were conversion to open heart surgery during operation, ejection fraction after operation, reintervention and other common postoperative complications. Data were pooled using the risk ratio or standardized mean difference with 95% confidence interval. Subgroup analysis, meta-regression, sensitivity analysis, egger's test and begg's test were performed. The original study protocol was registered prospectively with PROSPERO (CRD42021245858).

Results: There were 24 studies, a total of 92,499 patients, enrolled in our systematic review and meta-analysis, including 43,948 men and 48,551 women. Comprehensive analysis showed significant differences in gender in postoperative complications and survival after transcatheter aortic valve implantation. Men had a significantly higher risk of perivalvular leakage (risk ratio (RR) = 1.42; 95% CI: 1.15 to 1.75; p = 0.001; $I^2$ = 68%), but lower risk in bleeding (RR = 0.69; 95% CI: 0.61 to 0.79; p $<$ 0.00001; $I^2$ = 82%), vascular complications (RR = 0.56; 95% CI: 0.52 to 0.61; p $<$ 0.00001; $I^2$ = 48%), and stroke (RR = 0.86; 95% CI: 0.80 to 0.93; p $<$ 0.00001; $I^2$ = 12%). The thirty-day mortality of men is slightly lower than that of women (RR = 0.87; 95% CI: 0.81 to 0.93; p = 0.0001; $I^2$ = 47%), the difference in one-year mortality was also significant (RR = 1.20; 95% CI: 1.08 to 1.33; p = 0.0008; $I^2$ = 59%). Univariate meta-regression analyses showed that pulmonary hypertension is the major source of heterogeneity in bleeding.

Conclusions: Men after transcatheter aortic valve implantation have a lower risk of related postoperative complications, but a higher risk of paravalvular leak and no advantage in medium-term survival.