title: Clinical outcomes after trans-catheter aortic valve replacement in men and women in Ontario, Canada.
abstract: OBJECTIVE
  Our objective was to evaluate sex-differences in outcomes after trans-catheter aortic valve replacement (TAVR) in a population-based cohort from Ontario, Canada.
  
  
  BACKGROUND
  Prior studies comparing outcomes in men and women after TAVR have yielded divergent results. Some studies have suggested that women have better survival than men while others have not corroborated this finding.
  
  
  METHODS
  A retrospective observational cohort study was conducted using chart abstraction data on all TAVR procedures performed between 2007 and 2013 in Ontario, Canada. Patients who had emergency TAVR procedures were excluded. The primary outcome was all-cause mortality at 30-days and 1-year. Secondary outcomes included mortality at last follow-up, cause-specific, and all-cause hospital readmission. Inverse probability of treatment weighting (IPTW) using propensity score was used to adjust for baseline differences between men and women.
  
  
  RESULTS
  The final study cohort consisted of 453 women and 546 men with a mean follow-up of 3.5 years. Women were generally older and more frail but had less comorbid conditions. Women had lower unadjusted mean EuroScores (7% ± 5% vs 8% ± 7%; P = 0.008), but underwent significantly more trans-apical procedures (26.5% vs 19.2%; P = 0.006) than men. After IPTW, the groups were well balanced. Although mortality was numerically higher for women at 30-days (7.2% vs 5.4%), this was not statistically significant (P = 0.34). At 1-year, there was no difference in mortality (18.2% vs 19.2%; P = 0.85). There were no significant differences in all-cause readmission.
  
  
  CONCLUSIONS
  In this population-based cohort including all patients undergoing TAVR, mortality or all-cause readmission were not significantly different between men and women. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Czarnecki
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
authors.forename: Feng
authors.initials: F
authors.lastname: Qiu
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Koh
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
authors.forename: Treesa J
authors.initials: TJ
authors.lastname: Prasad
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.affiliation: St Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: Asim N
authors.initials: AN
authors.lastname: Cheema
authors.affiliation: London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
authors.forename: Michael W A
authors.initials: MWA
authors.lastname: Chu
authors.affiliation: University Health Network, Toronto, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Feindel
authors.affiliation: Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Fremes
authors.affiliation: Cardiac Care Network of Ontario, Canada.
authors.forename: Kori
authors.initials: K
authors.lastname: Kingsbury
authors.affiliation: Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.affiliation: St Michael's Hospital, University of Toronto, Ontario, Canada.|Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Peterson
authors.affiliation: Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
authors.affiliation: Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Strauss
authors.affiliation: Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.affiliation: Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009864:Ontario; D010359:Patient Readmission; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: aortic stenosis; sex differences; trans-catheter aortic valve replacement