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.
Abstract word count: 232