Clinical differences between men and women undergoing surgery for acute Type A aortic dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Type A aortic dissection is a life-threatening condition requiring surgical intervention.
• Sex-based differences in clinical presentation, outcomes, and prognosis after aortic dissection surgery are not well-established.
• Understanding these differences is crucial for personalized patient management.

Purpose of the Study:

• To investigate and compare clinical features, surgical outcomes, and long-term prognosis between men and women undergoing surgery for Type A aortic dissection.
• To identify potential sex-specific risk factors and outcomes in this patient population.

Main Methods:

• A retrospective analysis of 303 patients (147 women, 156 men) who underwent surgery for acute Type A aortic dissection between January 2004 and December 2016.
• Comparison of clinical characteristics, operative mortality, intensive care unit stay, mechanical ventilator support duration, and long-term survival and reoperation rates between male and female cohorts.
• Multivariate logistic regression analysis to identify independent risk factors for early death.

Main Results:

• Women were significantly older than men at the time of surgery (72.6 vs 63.0 years).
• Operative mortality was similar between sexes (8.2% in women vs 8.9% in men).
• Women had shorter intensive care unit stays and mechanical ventilator support durations.
• Ten-year actuarial survival rates were comparable (59.0% in women vs 65.7% in men).
• Male patients had a significantly higher rate of reoperation (53.1% vs 80.7% freedom from reoperation at 10 years).

Conclusions:

• There are no significant differences in early or long-term mortality between men and women following Type A aortic dissection surgery.
• Male patients demonstrate a higher need for reoperation related to aortic dissection during long-term follow-up.
• While early outcomes are similar, sex-specific considerations may be relevant for long-term management and surveillance strategies.