Sex-Based Differences in Dissection Patterns and Surgical Strategies in Tear-Oriented Repair for Acute Type A Aortic...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Acute Stanford type A aortic dissection (AAAD) is a life-threatening condition requiring prompt surgical intervention.
• Understanding sex-based differences in AAAD is crucial for optimizing clinical management and surgical approaches.

Purpose of the Study:

• To investigate sex-based variations in clinical presentation, aortic anatomy, surgical techniques, and outcomes among patients undergoing emergency surgery for AAAD.

Main Methods:

• Retrospective analysis of 148 consecutive patients (82 males, 66 females) who underwent surgery for AAAD.
• Comparison of demographic data, entry tear location, surgical procedures, and postoperative outcomes.
• Kaplan-Meier analysis for long-term survival and freedom from re-intervention.

Main Results:

• Female patients were older, with a higher prevalence of ascending aortic entry tears, often treated with hemiarch replacement.
• Male patients more frequently underwent total arch replacement due to distal tears and showed greater iliac artery involvement.
• No significant sex-based differences were observed in in-hospital mortality, major complications, long-term survival, or re-intervention rates.

Conclusions:

• The prevalence of ascending entry tears in females facilitates less extensive surgery without compromising outcomes.
• Emergent surgery for AAAD is appropriate in elderly female patients when dissection patterns are suitable.
• Sex-based anatomical variations in AAAD influence surgical strategy but not long-term results.