Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study

Nappi, Francesco; Petiot, S.; Salsano, Antonio; Singh, Sanjeet Singh Avtaar; Berger, J.; Kostantinou, Marisa; Bonnet, Severine; Gambardella, Ivancarmine; Biancari, Fausto; Almazil, Almothana; Santini, Francesco; Chaara, Rim; Fiore, Antonio

doi:10.3390/jcdd10040147

Cited by 8 publications

(7 citation statements)

References 42 publications

(103 reference statements)

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“…Several studies investigated whether there are sex-related differences in clinical and prognostic characteristics in patients with aortic dissection. In general, women tend to be older and leaner and to have higher rates of pericardial effusion/cardiac tamponade than men 11–13 . In addition, although both in-hospital and short-term mortality do not seem to differ between the sexes, 11–13 a recent meta-analysis demonstrated that women have higher mortality after 10 years of follow-up compared with men 12 …”

Section: Introductionmentioning

confidence: 99%

The influence of sex on left ventricular remodeling in patients with aortic dissection

Diniz,

Oliveira,

Rocha

et al. 2024

Journal of Cardiovascular Medicine

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Aims Patients with aortic dissection have a high prevalence of left ventricular structural alterations, including left ventricular hypertrophy (LVH), but little is known about the impact of sex on this regard. This study compared clinical, cardiac, and prognostic characteristics between men and women with aortic dissection. Methods We retrospectively assessed clinical and echocardiographic characteristics, and 1-year mortality in 367 aortic dissection patients (30% women; 66% with Stanford-A) who underwent echocardiography 60 days before or after the diagnosis of aortic dissection from three Brazilian centers. Results Men and women had similar clinical characteristics, except for higher age (59.4 ± 13.4 vs. 55.9 ± 11.6 years; P = 0.013) and use of antihypertensive classes (1.4 ± 1.3 vs. 1.1 ± 1.2; P = 0.024) and diuretics (32 vs. 19%; P = 0.004) in women compared with men. Women had a higher prevalence of LVH (78 vs. 65%; P = 0.010) and lower prevalence of normal left ventricular geometry (20 vs. 10%; P = 0.015) than men. Logistic regression analysis adjusted for confounding factors showed that women were less likely to have normal left ventricular geometry (odds ratio, 95% confidence interval = 0.42, 0.20–0.87; P = 0.019) and were more likely to have LVH (odds ratio, 95% confidence interval = 1.91, 1.11–3.27; P = 0.019). Conversely, multivariable Cox-regression analysis showed that women had a similar risk of death compared to men 1 year after aortic dissection diagnosis (hazard ratio, 95% confidence interval = 1.16, 0.77–1.75; P = 0.49). Conclusion In aortic dissection patients, women were typically older, had higher use of antihypertensive medications, and exhibited a greater prevalence of LVH compared with men. However, 1-year mortality after aortic dissection diagnosis did not differ between men and women.

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Section: Introductionmentioning

confidence: 99%

The influence of sex on left ventricular remodeling in patients with aortic dissection

Diniz,

Oliveira,

Rocha

et al. 2024

Journal of Cardiovascular Medicine

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“…In the contemporary age, type A acute aortic dissection (TAAAD) persists as a clinicopathological entity that poses a life-threatening risk coupled with a substantial possibility of mortality and morbidity. Fifty percent of patients with TAAAD die within 24 h. Estimates suggest that an additional 50% of patients may die before reaching a specialist aortic surgery referral centre [1][2][3][4][5][6][7][8]. The most effective treatment option for such patients is timely surgical repair.…”

Section: Introductionmentioning

confidence: 99%

“…Thanks to greater clinical awareness, diagnostic techniques, and inceptive management [9], there has been a rise in the number of cases diagnosed promptly and undergoing TAAAD repair in the previous decade. However, despite reports of lower operative mortality rates not exceeding 7% [10][11][12][13], survival rates following surgical procedures remain suboptimal, with high rates of in-hospital mortality (16-18%) [1][2][3]7,[14][15][16][17][18][19]. The implementation of appropriate interventions for specific patient populations has led to improved operative mortality and postoperative complication rates.…”

Section: Introductionmentioning

confidence: 99%

“…The consideration of the impact of various surgical strategies on outcomes requires more reliable data. Similarly, further analysis is needed on the impact of the volume-outcome ratio of the surgeon or centre on mortality, which is poorly understood at present [1,2,7,[20][21][22]. In this context, a greater comprehension of the factors influencing patient outcomes during surgical interventions can provide significant assistance to the decision-making process.…”

Section: Introductionmentioning

confidence: 99%

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Lactate-Based Difference as a Determinant of Outcomes following Surgery for Type A Acute Aortic Dissection: A Multi-Centre Study

Nappi,

Alzamil,

Salsano

et al. 2023

JCM

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Type A acute aortic dissection (TAAAD) is a serious condition within the acute aortic syndromes that demands immediate treatment. Despite advancements in diagnostic and referral pathways, the survival rate post-surgery currently sits at almost 20%. Our objective was to pinpoint clinical indicators for mortality and morbidity, particularly raised arterial lactate as a key factor for negative outcomes. Methods: All patients referred to the three cardiovascular centres between January 2005 and December 2022 were included in the study. The inclusion criteria required the presence of a lesion involving the ascending aorta, symptoms within 7 days of surgery, and referral for primary surgical repair of TAAAD based on recommendations, with consideration for other concomitant major cardiac surgical procedures needed during TAAAD and retrograde extension of TAAAD. We conducted an analysis of both continuous and categorical variables and utilised predictive mean matching to fill in missing numeric features. For missing binary variables, we used logistic regression to impute values. We specifically targeted early postoperative mortality and employed LASSO regression to minimise potential collinearity of over-fitting variables and variables measured from the same patient. Results: A total of 633 patients were recruited for the study, out of which 449 patients had complete preoperative arterial lactate data. The average age of the patients was 64 years, and 304 patients were male (67.6%). The crude early postoperative mortality rate was 24.5% (110 out of 449 patients). The mortality rate did not show any significant difference when comparing conservative and extensive surgeries. However, malperfusion had a significant impact on mortality [48/131 (36.6%) vs. 62/318 (19.5%), p < 0.001]. Preoperative arterial lactates were significantly elevated in patients with malperfusion. The optimal prognostic threshold of arterial lactate for predicting early postoperative mortality in our cohort was ≥2.6 mmol/L. Conclusion: The arterial lactate concentration in patients referred for TAAAD is an independent factor for both operative mortality and postoperative complications. In addition to mortality, patients with an upper arterial lactate cut-off of ≥2.6 mmol/L face significant risks of VA ECMO and the need for dialysis within the first 48 h after surgery. To improve recognition and facilitate rapid transfer and surgical treatment protocol, more diligent efforts are required in the management of malperfusion in TAAAD.

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“… 3 While some studies have demonstrated that surgically treated females with ATAAD have a higher odds of in-hospital mortality compared with males, 4 , 5 , 6 , 7 , 8 other studies have found no significant differences in in-hospital mortality between males and females after surgical repair of ATAAD. 9 , 10 , 11 , 12 A systematic review and meta-analysis reported no difference in early mortality between sexes after surgical repair of ATAAD. 3 , 13 , 14 , 15 , 16 However, published literature is fragmented and heterogenous, which limits tour ability to understand sex differences among ATAAD patients.…”

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confidence: 99%