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Operative Mortality After Type A Aortic Dissection Surgery: Differences Based on Sex and Age
Hong Liu1, Hai-Yang Li2,3, Yi-Lin Li2,3
1Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
JACC. Advances
|June 28, 2024
Summary
Sex differences in acute type A aortic dissection (ATAAD) mortality are controversial. This study found older females (over 55) have higher operative mortality than males, while younger females have similar risks.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Controversy exists regarding sex-based disparities in short-term mortality following acute type A aortic dissection (ATAAD).
- Understanding these differences is crucial for optimizing surgical outcomes in ATAAD patients.
Purpose of the Study:
- To investigate the impact of sex on 30-day operative mortality in surgically treated ATAAD.
- To identify if age modifies the association between sex and operative mortality in ATAAD.
Main Methods:
- Analysis of 5670 patients with surgically repaired ATAAD from the multicenter China 5A study.
- Operative mortality was the primary outcome, with age-related trends modeled using cubic splines.
- Propensity score analyses were used to adjust for potential confounding factors.
Main Results:
- Females (26.5%) were older and had fewer comorbidities than males (73.5%).
- Unadjusted mortality was higher in females (10.2%) versus males (8.2%, P=0.019), but not significant after propensity analysis.
- A significant interaction between sex and age (P=0.035) was observed: older age increased mortality risk more in females than males.
- Mortality risk diverged at 55 years; females <55 had similar odds to males, while females >55 had higher odds (OR: 1.420).
Conclusions:
- Female ATAAD patients under 55 years have similar operative mortality odds compared to males.
- Female ATAAD patients over 55 years face significantly higher operative mortality odds than males.
- Individualized risk assessment considering age and sex is essential for tailoring treatment strategies in ATAAD.
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