Differences among sexes in presentation and outcomes in acute type A aortic dissection repair

Objective: Female sex is a known risk factor in most cardiac surgery, including cor-onary and valve surgery, but unknown in acute type A aortic dissection repair.Methods: From 1996 to 2018, 650 patients underwent acute type A aortic dissec-tion repair; 206 (32%) were female, and 444 (68%) were male. Data were collected through the Cardiac Surgery Data Warehouse, medical record review, and National Death Index database. Results: Compared with men, women were significantly older (65 vs 57 years, P < .0001). The proportion of women and men inverted with increasing age, with 23% of patients aged less than 50 years and 65% of patients aged 80 years or older being female. Women had significantly less chronic renal failure (2.0% vs 5.4%, P = .04), acute myocardial infarction (1.0% vs 3.8%, P = .04), and severe aortic insufficiency. Women underwent significantly fewer aortic root replace-ments with similar aortic arch procedures, shorter cardiopulmonary bypass times (211 vs 229 minutes, P = .0001), and aortic crossclamp times (132 vs 164 minutes, P < .0001), but required more intraoperative blood transfusion (4 vs 3 units) compared with men. Women had significantly lower operative mortality (4.9% vs 9.5%, P = .04), especially in those aged more than 70 years (4.4% vs 16%, P = .02). The significant risk factors for operative mortality were male sex (odds ratio, 2.2), chronic renal failure (odds ratio, 3.4), and cardiogenic shock (odds ratio, 6.8). The 10-year survival was similar between sexes.Conclusions: Physicians and women should be cognizant of the risk of acute type A aortic dissection later in life in women. Surgeons should strongly consider opera-tions for acute type A aortic dissection in women, especially in patients aged 70 years or more. (J Thorac Cardiovasc Surg 2023;165:972-81)

Automated summary

Female sex is a known risk factor in most cardiac surgeries, but its association with acute type A aortic dissection repair is unclear. In this study, women were found to be older than men and had fewer comorbidities, shorter surgery time, but required more intraoperative blood transfusion. Women also had significantly lower operative mortality, especially in older age groups. Physicians and women should be aware of the risk of aortic dissection and consider surgery, especially in older female patients.