Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Research

Background:

• Type A Acute Aortic Dissection (TAAAD) is a life-threatening surgical emergency with significant morbidity and mortality.
• Existing data suggest sex-specific differences in TAAAD presentation and surgical management.
• Understanding these differences is crucial for optimizing patient outcomes.

Purpose of the Study:

• To investigate sex-specific differences in the presentation, surgical management, and outcomes of patients undergoing Type A Acute Aortic Dissection (TAAAD) repair.
• To analyze the impact of gender on operative mortality and long-term survival.
• To identify risk factors for mortality in female patients with TAAAD.

Main Methods:

• Retrospective review of 633 patients from three cardiac surgery departments (2005-2021).
• Confounder adjustment using doubly robust regression models and inverse probability of treatment weighting (IPTW) by propensity score.
• Subgroup analysis to identify mortality predictors in women.

Main Results:

• Women (30.3%) were older, with lower hemoglobin and eGFR than men.
• Men were more likely to undergo aortic root and arch repair.
• Operative mortality and early neurological complications were comparable; long-term survival showed no significant gender impact (HR 0.883).
• In women, elevated preoperative arterial lactate (OR 1.468) and mesenteric ischemia (OR 32.742) predicted increased operative mortality.

Conclusions:

• Advancing age and preoperative arterial lactate in female TAAAD patients may influence surgical approach towards more conservative strategies.
• Despite differences in presentation and surgical choices, postoperative survival is similar between genders.
• Preoperative lactate and mesenteric ischemia are critical factors impacting operative mortality in women with TAAAD.