Type A acute aortic dissection more fatal in women than men, but gap closing
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The mortality rate for women with type A acute aortic dissection remains higher than that for men with the condition, but has improved in the past decade, researchers reported.
“Data over the course of the last few decades demonstrate differences in both presentation and outcomes between males and females who have acute aortic dissection, with greater mortality among females. This study underscores the need for further interrogatories into these sex differences that may help provoke refined sex-directed strategies to further improve outcomes,” Thomas G. Gleason, MD, cardiac surgeon at Brigham and Women’s Hospital, said in a press release.
The researchers analyzed 2,823 patients (34% women) with type A acute aortic dissection who underwent operative repair or a surgical procedure as part of a hybrid repair from 1996 to 2018.
Sex differences
According to the researchers, women were more likely to be older than men and to have an intramural hematoma (19.4% vs. 13.2%; P < .001), complete lumen thrombosis (17.2% vs. 10.2%; P = .001) or partial lumen thrombosis (24.8% vs. 19.4%; P = .039).
Arch vessel and coronary artery involvement were similar in men and women, but aortic insufficiency was more prevalent in men (64.9% vs. 53.5%; P = .016), whereas women were more commonly presented with pericardial effusion (49.6% vs. 39.8%; P < .001) and pleural effusion (15.3% vs. 9.2%; P = .007), the researchers wrote.
Researchers found that male patients had greater median aortic diameters at the annulus (2.5 cm vs. 2.3 cm), root (4.3 cm vs 3.8 cm), and sinotubular junction (4 cm vs. 3.7 cm; P < .001 for all).
According to the researchers, tubular ascending aorta and arch dimensions were comparable and the distal extent of dissection was also similar in men and women at the ascending aorta, arch and descending aorta.
A complete arch replacement procedure was done more frequently in men (20.6% vs. 15.2%; P = .002) and men were more likely to undergo a Bentall procedure (32.4% vs. 22.8%; P < .001), according to the researchers.
The rate of aortic valve replacement was higher (34.5% vs. 26.6%; P < .001), and the median cerebral perfusion time (34 vs. 32 minutes; P = .036) and total cardiopulmonary bypass time (201 vs. 182 minutes; P < .001) were both longer in men, whereas in-hospital mortality occurred in 16.7% of women and 13.8% of men (P = .039), according to the researchers.
When comparing postoperative complication rates, there were no meaningful distinctions between men and women, with the exception of acute renal failure, which was lower in women (17.7% vs. 21.2%; P = .029), the researchers wrote.
In-hospital mortality
Female sex was a predictor of in-hospital mortality (OR = 1.4; P = .053), but in-hospital mortality was comparable in men and women when only the last decade of enrollment in the study was considered (OR = 0.93; P = .807), according to the researchers.
“Further study will be necessary to better understand the pathophysiologic mechanisms driving the development of acute aortic syndromes in each sex to more accurately stratify dissection risk and inform the decision for prophylactic aortic replacement,” the researchers wrote.
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