Abstract
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.