Sex‐based outcomes after surgery for acute type A aortic dissection

Abstract

Background While prior data have suggested worse outcomes in women after acute type A aortic dissection (ATAAD) repair when compared to men, results have been inconsistent across studies over time. This study sought to evaluate the impact of sex on short‐ and long‐term outcomes after ATAAD repair. Methods This was a retrospective study utilizing an institutional database of ATAAD repairs from 2007 to 2021. Patients were stratified according to sex. Kaplan–Meier survival estimation and multivariable Cox regression were performed. Supplementary analysis using propensity score matching was also performed. Results Of the 601 patients who underwent ATAAD repair, 361 were males (60.1%) and 240 (39.9%) were females. Females were significantly older, more likely to have hypertension, and more likely to have chronic lung disease. Females were also significantly more likely than males to undergo hemiarch replacement, while males were significantly more likely than females to undergo total arch replacement and frozen elephant trunk. Operative mortality was 9.4% among males and 13.8% among females, though this was not a statistically significant difference (p = .098). Postoperative complications were comparable between groups. Kaplan–Meier survival estimates were similar for men and women, and, on multivariable Cox regression, sex was not significantly associated with long‐term survival (hazard ratio: 1.00, 95% confidence interval: 0.73, 1.37, p = .986). Outcomes remained comparable after supplementary propensity score matched analysis. Conclusion ATAAD repair can be performed with comparable short‐term and long‐term outcomes in both men and women.

Sex differences in long-term outcomes following surgery for acute type A aortic dissection: a systematic review and meta-analysis

“…Across the 15 included studies, there were 7,608 male and 3,989 female patients. Of these, 12 reported single-center retrospective data (10,11,19,(26)(27)(28)(29)(30)(31)(32)(33)(34), one reported multi-center data 35, and two reported on large multi-center national or international datasets (9,17). A total of 13 studies published Kaplan-Meier curves for survival (9)(10)(11)19,(26)(27)(28)(30)(31)(32)(33)(34)(35) and four studies published curves for reoperation (9,17,19,28) and were subsequently included in the respective pooled Kaplan-Meier analyses.…”

“…Of these, 12 reported single-center retrospective data (10,11,19,(26)(27)(28)(29)(30)(31)(32)(33)(34), one reported multi-center data 35, and two reported on large multi-center national or international datasets (9,17). A total of 13 studies published Kaplan-Meier curves for survival (9)(10)(11)19,(26)(27)(28)(30)(31)(32)(33)(34)(35) and four studies published curves for reoperation (9,17,19,28) and were subsequently included in the respective pooled Kaplan-Meier analyses. Two studies included cohorts starting from the earliest timepoint and followed patients over the longest time span from 1996-2018 (9,32).…”

“…The NOS evaluation is displayed in Table 2. Nine of 16 studies included were scored eight or nine points suggesting they have good quality (9,11,17,19,(26)(27)(28)(29)32). Three studies scored less than six points which was due to no description of comparability of cohorts, or lack of information about the method for outcomes ascertainment and assessment (10,30,33).…”

Sex‐based differences in acute type A aortic dissection—Biology or bias?

“…Sex-based outcomes following repair of acute type A aortic dissection (ATAAD) has been of considerable interest among researchers and the study by Yousef et al is another attempt to establish the impact of gender on outcomes. 1 The authors have examined a large institutional database over a 15-year period and concluded that while there are differences in presentation, mortality is essentially similar between males and females. The patient numbers were substantial (n = 601) and multivariable Cox proportional-hazards regression model for mortality in the entire cohort confirmed that gender was not an independent risk factor.…”

“…Sex‐based outcomes following repair of acute type A aortic dissection (ATAAD) has been of considerable interest among researchers and the study by Yousef et al is another attempt to establish the impact of gender on outcomes 1 . The authors have examined a large institutional database over a 15‐year period and concluded that while there are differences in presentation, mortality is essentially similar between males and females.…”