Sex differences in short- and long-term survival after acute Type A aortic dissection

• Verfasst von: Pfeiffer, Philipp [VerfasserIn]
• Verfasst von: Brendel, Lena [VerfasserIn]
• Verfasst von: Rösch, Romina M. [VerfasserIn]
• Verfasst von: Probst, Chris [VerfasserIn]
• Verfasst von: Ghazy, Ahmed [VerfasserIn]
• Verfasst von: Zancanaro, Edoardo [VerfasserIn]
• Verfasst von: El Beyrouti, Hazem [VerfasserIn]
• Verfasst von: Treede, Hendrik [VerfasserIn]
• Verfasst von: Dohle, Daniel-Sebastian [VerfasserIn]
• Titel: Sex differences in short- and long-term survival after acute Type A aortic dissection
• Verf.angabe: Philipp Pfeiffer, Lena Brendel, Romina Maria Rösch, Chris Probst, Ahmed Ghazy, Edoardo Zancanaro, Hazem El Beyrouti, Hendrik Treede and Daniel-Sebastian Dohle
• E-Jahr: 2024
• Jahr: 7 March 2024
• Umfang: 13 S.
• Illustrationen: Illustrationen
• Fussnoten: Gesehen am 13.08.2024
• Titel Quelle: Enthalten in: Medicina
• Ort Quelle: Kaunas : Kaunas Univ. of Medicine, 2001
• Jahr Quelle: 2024
• Band/Heft Quelle: 60(2024), 3, Artikel-ID 443, Seite 1-13
• ISSN Quelle: 1648-9144
• DOI: doi:10.3390/medicina60030443
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: acute type A aortic dissection
• Sach-SW: aortic surgery
• Sach-SW: cardiac surgery
• Sach-SW: long-term survival
• Sach-SW: sex differences
• K10plus-PPN: 1898513023

Abstract

Background and Objectives: Acute type A aortic dissection (AAD) is a life-threatening disease. No differences between men and women have been made in the treatment of AAD so far and knowledge about sex differences regarding long-term outcomes is limited. Materials and Methods: Between 01/2004 and 12/2021, 874 patients were operated on for AAD, including 313 (35.8%) women and 561 (64.2%) men. Clinical and surgical records, including long-term follow-up information, were obtained and analyzed retrospectively. To account for differences in the outcome determined by different preoperative life expectancies, a subgroup analysis for a set of patients matched according to their remaining life expectancy was performed. Results: At the time of AAD, women were older than men (69.1 ± 13.0 vs. 61.8 ± 13.3 years, p < 0.001) and had a shorter remaining statistical life expectancy (18.6 ± 10.8 vs. 21.4 ± 10.4 years, p < 0.001). Significantly more DeBakey type II AAD was found in women (37.1% vs. 25.7%, p < 0.001). Comorbidities and preoperative status at the time of presentation were similar in women and men. More hemiarch procedures (63.3% vs. 52.0%, p < 0.001) and less arch replacements (8.6% vs. 16.6%, p < 0.001) were performed in women, resulting in shorter cross-clamp times for women (92 ± 39 vs. 102 ± 49 min, p < 0.001). The in-hospital mortality was similar in women and men (11.5% vs. 12.7%, p = 0.618). Long-term survival was significantly shorter in women compared to men (9.8 [8.1-11.5] vs. 15.1 [11.9-18.4] years, p = 0.011). A matched subgroup analysis revealed that when comparing groups with a similar remaining life expectancy, the long-term survival showed no significant differences between women and men (9.8 [7.9-11.6] vs. 12.4 [10.1-14.7] years, p = 0.487). Conclusions: There are sex differences in AAD, with DeBakey type II dissection being more frequent in women. The seemingly worse long-term outcome can mostly be attributed to the shorter remaining statistical life expectancy at the time of presentation.