Sex-based outcomes in surgical repair of acute type A aortic dissection: A meta-analysis and meta-regression

Lawrence, Kyle W.; Yin, Kanhua; Connelly, Haley L.; Datar, Yesh; Brydges, Hilliard T.; Balasubramaniyan, Ramkumar; Karlson, Karl J.; Edwards, Niloo M.; Dobrilovic, Nikola

doi:10.1016/j.jtcvs.2022.02.005

Cited by 19 publications

(17 citation statements)

References 30 publications

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“…Like ours, this study also demonstrated that females with ATAAD presented later in life than males did, and that males were more likely overall to undergo total arch and elephant trunk procedures. Consistent with our study's findings, a meta-analysis published in 2022 demonstrates comparable short-term mortality and postoperative outcomes between men and women after ATAAD repair [15], and another 2022 study using the Taiwan National Health Insurance Research database found no significant sex-related differences in in-hospital mortality or all-cause mortality between men and women undergoing ATAAD repair [16].…”

Section: Discussionsupporting

confidence: 90%

Sex-based Outcomes after Surgery for Acute Type A Aortic Dissection

Yousef

Navid

Zhu³

et al. 2022

Preprint

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Background: While prior data have suggested worse outcomes in women after acute type A aortic dissection (ATAAD) repair when compared to men, results have been inconsistent across studies over time. This study sought to evaluate the impact of sex on short- and long-term outcomes after ATAAD repair. Methods: This was a retrospective study utilizing an institutional database of ATAAD repairs from 2007 to 2021. Patients were stratified according to sex. Kaplan-Meier survival estimation and multivariable Cox regression were performed. Supplementary analysis using propensity score matching was also performed. Results: Of the 601 patients who underwent ATAAD repair, 361 were males (60.1%) and 240 (39.9%) were females. Females were significantly older, more likely to have hypertension, and more likely to have chronic lung disease. Females were also significantly more likely than males to undergo hemiarch replacement, while males were significantly more likely than females to undergo total arch replacement and frozen elephant trunk. Operative mortality was 9.4% among males and 13.8% among females, though this was not a statistically significant difference (p=0.098). Postoperative complications were comparable between groups. Kaplan-Meier survival estimates were similar for men and women, and, on multivariable Cox regression, sex was not significantly associated with long-term survival (HR 1.00, 95% CI: 0.73, 1.37, p=0.986). Outcomes remained comparable after supplementary propensity score matched analysis. Conclusion: ATAAD repair can be performed with comparable short-term and long-term outcomes in both men and women.

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Section: Discussionsupporting

confidence: 90%

Sex-based Outcomes after Surgery for Acute Type A Aortic Dissection

Yousef

Navid

Zhu³

et al. 2022

Preprint

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“…Sex was not associated with short-term or long-term mortality in type B AAD patients who underwent thoracic endovascular aortic repair (TEVAR) [ 18 , 26 , 27 ]. As aortic valve-sparing root replacement and antegrade cerebral perfusion strategies during arch reconstruction increased over the past decade, in-hospital mortality due to type A AADs has decreased in both men and women [ 15 , 21 , 27 ], mitigating sex differences in short-term outcomes was found to disappear in several recent studies [ 20 , 23 , 27 , 28 , 29 , 30 ]. Despite these improvements, women with type A AAD are more likely to suffer neurological dysfunction due to decreased perfusion or ischemia prior to intervention and post-operation [ 21 , 22 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

“…Men have been found to have longer intensive care unit stays, ventilator support, surgical procedure time, and cardiac-pulmonary bypass time [ 28 , 32 ]. Importantly, reoperation rates are significant higher in men, which has been attributed to an increased propensity for bleeding in a recent meta-analysis [ 28 , 30 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Thoracic Aortic Dissection

Zhou

Cecchi

Prakash

et al. 2022

Genes

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Thoracic aortic aneurysms involving the root and/or the ascending aorta enlarge over time until an acute tear in the intimal layer leads to a highly fatal condition, an acute aortic dissection (AAD). These Stanford type A AADs, in which the tear occurs above the sinotubular junction, leading to the formation of a false lumen in the aortic wall that may extend to the arch and thoracoabdominal aorta. Type B AADs originate in the descending thoracic aorta just distal to the left subclavian artery. Genetic variants and various environmental conditions that disrupt the aortic wall integrity have been identified that increase the risk for thoracic aortic aneurysms and dissections (TAD). In this review, we discuss the predominant TAD-associated risk factors, focusing primarily on the non-genetic factors, and discuss the underlying mechanisms leading to TAD.

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“…In a recent metanalysis of nine studies comparing clinical outcomes according to gender in type A AAD patients treated surgically [ 28 ], women and men showed similar in-hospital/30-day mortality (RR = 1.04; 95% CI, 0.85–1.28; p = 0.67), risk of post-surgical stroke (RR = 1.07; 95% CI, 0.91–1.25; p = 0.43), and dialysis (RR = 0.84; 95% CI, 0.59–1.19; p = 0.32).On the other hand, a lower risk of reintervention for bleeding (RR = 0.84; 95% CI, 0.75–0.94; p < 0.01) was shown in women [ 28 ].…”

Section: Impact Of Gender In Aadmentioning

confidence: 99%

Gender Differences in Acute Aortic Dissection

Bossone

Carbone

Eagle

2022

JPM

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Cardiovascular disease (CVD) represents the most important cause of mortality and morbidity worldwide. There is heterogeneity in the epidemiology and management of CVD between male and female patients. In the specific case of acute aortic dissection (AAD), women, at the time of diagnosis, are older than men and complain less frequently of an abrupt onset of pain with delayed presentation to the emergency department. Furthermore, a history of hypertension and chronic obstructive pulmonary disease is more common among women. In type A AAD, women more often experience pleural effusion and coronary artery compromise, but experience less neurological and malperfusion symptoms. They undergo less frequent surgical treatment and have higher overall in-hospital mortality. Conversely, in type B AAD no significant differences were shown for in-hospital mortality between the two genders. However, it should be highlighted that further studies are needed in order to develop AAD gender specific preventive, diagnostic and therapeutic strategies.

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Sex-based outcomes in surgical repair of acute type A aortic dissection: A meta-analysis and meta-regression

Cited by 19 publications

References 30 publications

Sex-based Outcomes after Surgery for Acute Type A Aortic Dissection

Sex-based Outcomes after Surgery for Acute Type A Aortic Dissection

Risk Factors for Thoracic Aortic Dissection

Gender Differences in Acute Aortic Dissection

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