Gender differences in patients undergoing surgery for acute type A aortic dissection

Abstract

Objectives: The impact of gender on preoperative characteristics and postoperative outcomes in patients undergoing surgery for acute type A aortic dissection rarely has been investigated.

Methods: We reviewed the records of 504 patients (245 women and 259 men) who underwent surgery for acute type A aortic dissection between August 2006 and December 2013. Women were older (71.5 vs 59.7 years; P < .001) and smaller (body surface area 1.5 vs 1.9 m(2); P < .001) than men. Early and long-term outcomes were compared between men and women.

Results: Operative mortality (<30 days) was similar between the groups (4.5% vs 5.8%; P = .646). Multivariable logistic regression analysis demonstrated that myocardial ischemia (odds ratio [OR], 5.48; 95% confidence interval [CI], 2.00-15.00; P < .001), neurologic ischemia (OR, 6.64; 95% CI, 2.26-19.48; P < .001), and shock/tamponade (OR, 3.74; 95% CI, 1.49-9.40; P = .005) were independent predictors of operative mortality. At 5 years, there was no significant difference in survival between the groups (80.1% vs 89.3%; P = .067). Cox regression analysis demonstrated that myocardial ischemia (hazard ratio [HR], 2.40; 95% CI, 1.21-4.74; P = .012), nonprescription of beta-blockers at discharge (HR, 4.27; 95% CI, 2.43-7.50; P < .001), and nonprescription of angiotensin II receptor blockers at discharge (HR, 2.39; 95% CI, 1.14-5.01; P = .021) were independent predictors of late mortality. Female gender was not an independent predictor of operative and late mortality.

Conclusions: There are no differences in early and long-term outcomes between male and female patients undergoing surgery for acute type A aortic dissection.

Keywords: aorta; aortic dissection; aortic surgery; sex; surgery.