INTRODUCTION
Several sex-based differences in the pathophysiology of aortic diseases
have been established, such as later presentation of women with acute
type A aortic dissection (ATAAD) [1] and faster growth rate of
thoracic aortic aneurysms in women when compared to men [2]. In
light of these differences, studies have also been conducted to
investigate potential differences in sex-based outcomes after ATAAD
repair. Some data have suggested worse outcomes in women, though there
have been conflicting findings and inconclusive results among these
studies over time [3,4,5]. Moreover, it is unclear whether findings
of worse outcomes in women were actually attributable to sex-based
differences in pathophysiology and initial presentation. Some
hypothesize that women have had worse outcomes and higher mortality
because of more frequent atypical clinical presentations, leading to
considerable delays in diagnosis and management [6]. Over the past
decade, outcomes of ATAAD repair have improved significantly, due to
advancements in diagnostic methods, cerebral perfusion strategies,
spinal cord protection, surgical techniques, and endovascular
technologies [7]. Whether sex-related disparities in outcomes of
ATAAD repair persist in the modern era is not yet well-established.
To help clarify these questions, we present sex-based outcomes from our
experience of ATAAD repair, with additional propensity score matched
analysis to eliminate the effects of age, type of repair, and other
confounding variables on outcomes.