Sex differences in type A acute aortic dissection: a systematic review and meta-analysis.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Medical Research

Background:

• Acute aortic dissection (AAD) exhibits significant sex heterogeneity, with existing reports being incomplete and sometimes contradictory.
• Understanding these sex differences is crucial for optimizing patient management and outcomes in type A AAD.

Approach:

• A systematic review and meta-analysis synthesized data from 16 studies (2004-2022) involving 16,069 patients (7,142 women, 8,927 men) with type A AAD.
• Analysis focused on surgically treated patients, comparing clinical features, management, and outcomes between sexes using random-effects models.

Key Points:

• Women with type A AAD were older, had lower BMI and creatinine, but more diabetes and pericardial effusion/tamponade.
• Active smoking, bicuspid aortic valve, and prior cardiac surgery were less frequent in women.
• In-hospital surgical mortality showed no significant sex difference, but men had higher 5- and 10-year survival rates.

Conclusions:

• A distinct female phenotype in type A AAD necessitates personalized management and tailored preventive strategies.
• Long-term survival disparities highlight the need for sex-specific research and clinical approaches in AAD management.