Background <p>The predictive role of right ventricular-pulmonary arterial (RV-PA) uncoupling following transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) is inconsistent. Thus, this meta-analysis aimed to evaluate the prognostic value of RV-PA coupling in patients undergoing TAVR.</p> Methods <p>We systematically searched PubMed, Embase, and Web of Science databases for studies reporting the prognostic relevance of RV-PA coupling in patients undergoing TAVR. Fixed- or random-effects models were employed according to heterogeneity. Subgroup analyses were conducted to evaluate the influence of study characteristics on the analyzed results.</p> Results <p>Eighteen studies involving 5,905 patients were included. The pooled results demonstrated that RV-PA uncoupling prior to TAVR was associated with the increased all-cause mortality risk, with a hazard ratio (HR) of 2.36 (95% CI: 1.76–3.16) in univariate analysis and an adjusted hazard ratio (aHR) of 2.01 (95% CI: 1.40–2.89) in multivariate analysis. Moreover, both non-severe RV-PA (HR = 1.71, 95% CI: 1.02–2.86) and severe RV-PA uncoupling (HR = 2.73, 95% CI: 1.50–4.95) were associated with elevated mortality risk in univariate analysis. Multivariate analysis showed increased all-cause mortality risk in patients with non-severe/severe uncoupling, but these findings were not statistically significant.</p> Conclusion <p>RV-PA uncoupling was identified as a predictor of adverse outcomes after TAVR. Incorporating assessment of RV-PA coupling may enhance risk stratification and prognostic prediction in the TAVR patient population.</p> Graphical Abstract <p></p>