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Sex-based Outcomes after Surgery for Acute Type A Aortic Dissection
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  • Sarah Yousef,
  • Forozan Navid,
  • Jianhui Zhu,
  • James Brown,
  • Derek Serna-Gallegos,
  • Edgar Aranda-Michel,
  • Valentino Bianco,
  • Danny Chu,
  • Ibrahim Sultan
Sarah Yousef
University of Pittsburgh Department of Cardiothoracic Surgery

Corresponding Author:yousefs@upmc.edu

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Forozan Navid
University of Pittsburgh Department of Cardiothoracic Surgery
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Jianhui Zhu
UPMC Heart and Vascular Institute
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James Brown
University of Pittsburgh Department of Cardiothoracic Surgery
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Derek Serna-Gallegos
University of Pittsburgh Department of Cardiothoracic Surgery
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Edgar Aranda-Michel
University of Pittsburgh Department of Cardiothoracic Surgery
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Valentino Bianco
University of Pittsburgh Department of Cardiothoracic Surgery
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Danny Chu
University of Pittsburgh Department of Cardiothoracic Surgery
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Ibrahim Sultan
University of Pittsburgh Department of Cardiothoracic Surgery
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Abstract

Background: While prior data have suggested worse outcomes in women after acute type A aortic dissection (ATAAD) repair when compared to men, results have been inconsistent across studies over time. This study sought to evaluate the impact of sex on short- and long-term outcomes after ATAAD repair. Methods: This was a retrospective study utilizing an institutional database of ATAAD repairs from 2007 to 2021. Patients were stratified according to sex. Kaplan-Meier survival estimation and multivariable Cox regression were performed. Supplementary analysis using propensity score matching was also performed. Results: Of the 601 patients who underwent ATAAD repair, 361 were males (60.1%) and 240 (39.9%) were females. Females were significantly older, more likely to have hypertension, and more likely to have chronic lung disease. Females were also significantly more likely than males to undergo hemiarch replacement, while males were significantly more likely than females to undergo total arch replacement and frozen elephant trunk. Operative mortality was 9.4% among males and 13.8% among females, though this was not a statistically significant difference (p=0.098). Postoperative complications were comparable between groups. Kaplan-Meier survival estimates were similar for men and women, and, on multivariable Cox regression, sex was not significantly associated with long-term survival (HR 1.00, 95% CI: 0.73, 1.37, p=0.986). Outcomes remained comparable after supplementary propensity score matched analysis. Conclusion: ATAAD repair can be performed with comparable short-term and long-term outcomes in both men and women.
20 Jul 2022Submitted to Journal of Cardiac Surgery
20 Jul 2022Submission Checks Completed
20 Jul 2022Assigned to Editor
20 Jul 2022Reviewer(s) Assigned
11 Aug 2022Review(s) Completed, Editorial Evaluation Pending
12 Aug 2022Editorial Decision: Revise Major
24 Aug 20221st Revision Received
25 Aug 2022Submission Checks Completed
25 Aug 2022Assigned to Editor
25 Aug 2022Reviewer(s) Assigned
25 Aug 2022Review(s) Completed, Editorial Evaluation Pending
25 Aug 2022Editorial Decision: Accept
02 Oct 2022Published in Journal of Cardiac Surgery. 10.1111/jocs.16988