Impact of Female Sex on Outcomes of Patients Undergoing Thoracic Endovascular Aortic Aneurysm Repair: A Ten-Year Retrospective Nationwide Study in France

Abstract

The impact of sex on the outcomes of patients with cardiovascular disease is still incompletely understood. The aim of this nationwide multicenter observational study was to investigate the impact of sex on post-operative outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR) for intact thoracic aortic aneurysm (iTAA). The French National Health Insurance Information System was searched to identify these patients over a ten-year retrospective period. Post-operative outcomes, 30-day and overall mortality were recorded. Among the 7383 patients included (5521 men and 1862 women), females were significantly older than males (66.8 vs. 64.8 years, p < 0.001). They were less frequently diagnosed with cardiovascular comorbidities. Post-operatively, women had less frequently respiratory (10.9 vs. 13.7%, p = 0.002) as well as cardiac complications (34.3 vs. 37.3%, p = 0.023), but they had more frequently arterial complications (52.8 vs. 49.8%, p = 0.024). There was no significant difference on overall mortality for a mean follow-up of 2.2 years (26.9 vs. 27.6%, p = 0.58). In the multivariable regression model, female sex was not associated with 30-day or overall mortality. Although women had a favorable comorbidity profile, the short-term and long-term survival was similar. The significantly higher rate of arterial complications suggests that women may be at higher risk of access-vessel-related complications.

Sex-related Outcomes after Thoracic Endovascular Repair for intact isolated Descending Thoracic Aortic Aneurysm

“…[2][3][4] Since then, several meta-analyses and large registry studies have suggested that females may have delayed diagnosis, and may be at higher risk of perioperative mortality and morbidity following vascular interventions in the aorta and peripheral arteries. [5][6][7] Prior studies specifically studying sex-related outcomes after thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm (TAA) have had conflicting results. Some authors suggested higher perioperative and midterm mortality in females, although these differences were not statistically significant.…”

“…To identify and address potential disparities in outcomes, many leading medical journals and scientific bodies required sex to be reported in every study 2–4 . Since then, several meta-analyses and large registry studies have suggested that females may have delayed diagnosis, and may be at higher risk of perioperative mortality and morbidity following vascular interventions in the aorta and peripheral arteries 5–7 …”