Gender-related differences in patients with acute aortic dissection type A

Rylski, Bartosz; Georgieva, Nikolina; Beyersdorf, Friedhelm; Büsch, Christopher; Boening, Andreas; Haunschild, Josephina; Etz, Christian D.; Luehr, Maximilian; Kallenbach, Klaus

doi:10.1016/j.jtcvs.2019.11.039

Cited by 72 publications

(89 citation statements)

References 23 publications

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“…Despite the observed gender-specific differences, women and men had an acceptable 30-day mortality of 19.0% vs. 16.5% and a total 30-day mortality of 17.4%, overall comparable to the results of Boening et al and Rylski et al who reported a total 30-day mortality of 16.9% [22], 16.6% in the male group but a lower mortality of 16.3% in the female group [13] in their large analysis of the German registry for Acute Aortic Dissection type A (GERAADA).…”

Section: Discussionsupporting

confidence: 82%

“…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: 96%

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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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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 96%

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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“…In type A AAD population, women had a higher postoperative mortality rate according to IRAD data [ 2 , 20 ]. Nevertheless, several other recent cohort articles concluded no difference in either in-hospital mortality or 30-day mortality between female and male patients with type A AAD following emergent surgeries [ 3 , 18 , 21 – 23 ]. In the analysis of cumulative all-cause mortality, Smedberg et al showed that female patients with type A AAD had no higher risk for long-term mortality after open surgery [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Sex-related differences on the risks of in-hospital and late outcomes after acute aortic dissection: A nationwide population-based cohort study

et al. 2022

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Objective The aim of this study is to evaluate the sex-related differences on the risks of perioperative and late outcomes for adult acute aortic dissection (AAD) patients following surgical management. Methods and results By using Taiwan National Health Insurance Research Database, totally 1,410 female and 3,432 male patients were identified to first-ever receive type A AAD open surgery or type B AAD stenting treatment from 2004 to 2013. We assessed the sex-related difference on outcomes, including in-hospital mortality, all-cause mortality, aortic death, redo aortic surgery, ischemic stroke, and depression during the follow-up period. The analysis was done separately for type A and type B surgeries. Results On average, female patients diagnosed with AAD were older than males. There was no significant sex difference of in-hospital mortality or all-cause mortality for both type A open and type B stent surgeries. The risk of redo aortic surgery was significantly greater in males than females (7.8% vs. 4%; unadjusted subdistribution hazard ratio [SHR] 0.51, 95% CI 0.38–0.69) for type A open surgery, but not for type B stent surgery. Noticeably, the risk of newly-diagnosed depression was significantly greater in females than males (8% vs. 5.1%; unadjusted SHR 1.6, 95% CI 1.24–2.06) for type A open surgery, but not for type B stent surgery. Conclusions No significant sex-related difference was found for the in-hospital mortality or accumulative all-cause mortality. However, there were more redo aortic surgeries for males and more postoperative depression for females in type A AAD population.

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“…Acute type A aortic dissection affected men more commonly, and about two-thirds occurred in men [ 24 , 33 ]. Male gender was found to independently predict POHL in this study.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and in-hospital mortality of postoperative hyperlactatemia in patients after acute type A aortic dissection surgery

Wang

Huang

et al. 2021

BMC Cardiovasc Disord

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Background Hyperlactatemia may be caused by increased production due to tissue hypoxia or non-hypoxia. The aim of this study was first to identify risk factors for postoperative hyperlactatemia (POHL) after Stanford type A acute aortic dissection surgery (AADS) and construct a predictive model, and second to evaluate the impact of POHL on prognosis. Methods This retrospective study involved patients undergoing AADS from January 2016 to December 2019 in Wuhan Union Hospital. Multivariate logistic regression analysis was performed to identify independent risk factors for POHL. A nomogram predicting POHL was established based on these factors and was validated in the original dataset. The receiver operating characteristic curve was drawn to assess the ability of postoperative lactate levels to predict the in-hospital mortality. Results A total of 188 patients developed POHL after AADS (38.6%). Male gender, surgery history, red blood cell transfusion and cardiopulmonary bypass time were identified as independent predictors. The C-index of the prediction model for POHL was 0.72, indicating reasonable discrimination. The model was well calibrated by visual inspection and goodness-of-fit test (Hosmer–Lemeshow χ2 = 10.25, P = 0.25). Decision and clinical impact curves of the model showed good clinical utility. The overall in-hospital mortality rate was 10.1%. Postoperative lactate levels showed a moderate predictive power for postoperative in-hospital mortality (C-index: 0.72). Conclusion We developed and validated a prediction model for POHL in patients undergoing AADS, which may have clinical utility in personal risk evaluation and preventive interventions. The POHL could be a good predictor for in-hospital mortality.

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Gender-related differences in patients with acute aortic dissection type A

Cited by 72 publications

References 23 publications

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

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

Sex-related differences on the risks of in-hospital and late outcomes after acute aortic dissection: A nationwide population-based cohort study

Risk factors and in-hospital mortality of postoperative hyperlactatemia in patients after acute type A aortic dissection surgery

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