Gender differences in patients undergoing surgery for acute type A aortic dissection

Fukui, Toshihiro; Tabata, Minoru; Morita, Satoshi; Takanashi, Shuichiro

doi:10.1016/j.jtcvs.2015.06.031

Cited by 61 publications

(53 citation statements)

References 36 publications

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“…Other predictors of long-term mortality may be female sex, and a history of atherosclerosis (28), but these factors did not reach statistical significance in WATAS. Interestingly, WATAS identified a univariate association of male sex with late aortic events, where another study confirmed such univariate association of male sex with late aortic reoperation after AAAD repair (31). Finally, WATAS identified a marginal association of Marfan syndrome with late aortic events, but other studies established Marfan syndrome as an independent predictor of late aortic events (22,32).…”

Section: Other Clinical Predictors Of Late Outcomementioning

confidence: 96%

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Kodolitsch¹,

Wilson²,

Schuler³

et al. 2017

Cardiovasc. Diagn. Ther.

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Background: Early survivors of acute type A aortic dissection (AAAD) remain at risk for late death and late aortic events. However, the frequency and long-term effects of warfarin anticoagulation on long-term outcome in post-surgical AAAD survivors have not been elucidated. Methods:Two tertiary care centers performed a retrospective observational cohort study of warfarin anticoagulation in AAAD in 243 persons with early survival of surgical repair (WATAS). Serial postoperative tomographic imaging was available in 106 persons.Results: A total of 88 postoperative AAAD survivors (36%) were on long-term warfarin anticoagulation.The indication for anticoagulation was a mechanical aortic prosthesis in 46 (52%), atrial fibrillation in 33 (38%), stroke in 7 (8%), and pulmonary embolism in 1 (1%). The indication for anticoagulation remained unclear in 1 person (1%). Survival and aortic event free survival were 98.3±0.01 and 98.7±0.01 at 1 year, and 76.4±0.03 and 91.8±0.02 at 5 years, respectively, with no differences irrespective of warfarin anticoagulation. Multivariate Cox regression analysis established higher age (P<0.001), and operation extending into the descending aorta (P=0.030) as independent predictors of late death. Follow-up without tomographic imaging independently predicted increased long-term mortality (P<0.001) and lower rates of documented aortic events (P=0.003). Kaplan-Meyer analysis showed a relationship of aortic diameter growth ≥0.5 cm per year with late death (P=0.041) and with late aortic events (P<0.001). However, rapid aortic growth did not relate to warfarin anticoagulation.Conclusions: Warfarin anticoagulation is frequent in postsurgical AAAD and it is administered for vital indications. Warfarin anticoagulation does not relate to late mortality or to late aortic events. Rapid aortic growth predicts late mortality and late aortic events, but warfarin anticoagulation is not associated with aortic growth. Follow-up tomographic imaging is mandatory for long-term survival after surgical repair of AAAD. von Kodolitsch et al. Warfarin in aortic dissection

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Section: Other Clinical Predictors Of Late Outcomementioning

confidence: 96%

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Kodolitsch¹,

Wilson²,

Schuler³

et al. 2017

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

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“…They found that risk factors for late death were patent distal false lumen, older age, and male sex and risk factors for late aortic events were patent distal false lumen, Marfan syndrome, and distal aorta over 45 mm in diameter. Fukui et al (14) reported a superb early mortality of 5.2% in 504 patients with acute type A dissection over a 7-year period. The TAR was performed in 163 (32.3%) patients.…”

Section: Arch Replacementmentioning

confidence: 99%

Current surgical results of acute type A aortic dissection in Japan

Okita¹

2016

Ann. Cardiothorac. Surg.

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Current surgical results of acute type A aortic dissection in Japan are presented. According to the annual survey by the Japanese Association of Thoracic Surgery, 4,444 patients with acute type A aortic dissection underwent surgical procedures and the overall hospital mortality was 9.1% in 2013. The prevalence of aortic root replacement with a valve sparing technique, total arch replacement (TAR), and frozen stent graft are presented and strategies for thrombosed dissection or organ malperfusion syndrome secondary to acute aortic dissection are discussed.

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“…As in coronary disease, delayed presentation and diagnosis in women due to less typical pain, older age and different comorbidities were described as potential risk factors for a worse outcome in female patients after surgery for AADA [2,5]. In contrast to these findings, female gender was not associated with a worse outcome in recent studies [3,4,12,13]. Several studies on the risk factors for mortality after surgery for AADA included gender as risk factor [4,14], but information about sex-specific risk factors of women and men is rare.…”

Section: Introductionmentioning

confidence: 98%

“…Acute aortic dissection type A (AADA) is one of the major causes of death in cardiovascular disease for women and men [1,2] and requires early surgical treatment to avoid live-threatening complications like aortic rupture, tamponade and malperfusion. Men are affected by AADA about twice as often compared to the incidence in women and present at younger age [2][3][4] and with considerable differences in comorbidities and risk factors [5][6][7]. The impact of gender in cardiovascular surgery has been investigated extensively during the past decades and women were shown to have worse outcomes after coronary bypass surgery [8,9].…”

Section: Introductionmentioning

confidence: 99%

Sex-specific risk factors for early mortality and survival after surgery of acute aortic dissection type a: a retrospective observational study

Friedrich

Salem

Puehler

et al. 2020

J Cardiothorac Surg

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Background: Although gender-related disparities in cardiovascular surgery have been investigated extensively in the past decades, knowledge about the impact of gender on outcomes after surgery for acute aortic dissection type A (AADA) is sparse. This study investigated the impact of gender on early morbidity and mortality and followup outcome in patients after surgery for AADA and to analyze gender-related risk factors for 30-day mortality. Methods: This retrospective study included 368 consecutive patients (male 65.8% vs. female 34.2%) undergoing surgery for AADA between 2001 and 2016 at our department. Survival was estimated by Kaplan-Meier curves. Risk factors for 30-day mortality were assessed by multivariable logistic regression and interaction analysis. Results: Women were older (70.7 years vs. 60.6 years; p < 0.001) and showed a higher logistic EuroSCORE I (31.0% vs. 19.7%, p < 0.001). In the male group, a higher portion of smokers (27.6% vs. 16.0%, p = 0.015) and intraoperatively, more complex procedures and longer cardiopulmonary bypass (CPB) (171 min vs. 149 min, p = 0.001) and cross-clamping times (94 min vs. 85 min, p = 0.018) occurred. 30-day mortality was 19.0% in the female and 16.5% in the male group (p = 0.545). Predictive for 30-day mortality in both genders was intraoperative blood transfusion, while in the female group chronic obstructive pulmonary disease (COPD), peripheral arterial disease and preoperative intubation were predictive. Preoperative cardiopulmonary resuscitation and duration of CPB time were predictors only in males. Averaged follow-up time was 5.2 years and survival did not differ between genders, even if it was stratified by age over 70 years. Conclusions: This analysis demonstrated a similar and satisfactory survival in both genders after surgical treatment of AADA. Women and men differed significantly in age, unadjusted and adjusted risk factors and complexity of surgical treatment, but gender itself was no risk factor for mortality. These results suggest that the decision-making for surgical treatment should not depend on gender, but that accounting for sex-specific risk factors rather than common risk factors may help to improve the outcome in both genders.

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Gender differences in patients undergoing surgery for acute type A aortic dissection

Abstract: There are no differences in early and long-term outcomes between male and female patients undergoing surgery for acute type A aortic dissection.

Cited by 61 publications

References 36 publications

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Current surgical results of acute type A aortic dissection in Japan

Sex-specific risk factors for early mortality and survival after surgery of acute aortic dissection type a: a retrospective observational study

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