Abstract 9060: Do Women Fare Differently After Repair of Acute Type a Aortic Dissection?

Abstract

Introduction: Given that the data regarding sex-based differences in presentation, management and outcomes following repair of acute type A aortic dissection (ATAAD) is sparse and inconsistent, we sought to examine the contemporary practice pattern and outcomes of ATAAD repair in females, as compared with men. Hypothesis: We hypothesize that female patients undergoing surgical repair of acute type A aortic dissection will have 30-day morbidity and mortality rates comparable to their matched control male peers, although this may be impacted by age; sex, body mass index, advanced age, hemodynamic instability at clinical presentation, and presence of a preoperative malperfusion syndrome, are all independent risk factors for poorer short-term outcomes.. Methods: Out of 240 cases of ATAAD between June 2014 and December 2019, 231 patients were divided into 2 groups based on sex. From this, 47 pairs of propensity-matched patients were analyzed with respect to operative data and short-term clinical outcomes. Results: Overall 30-day mortality for our entire study cohort was 11.8% (27 deaths), significantly greater in females (21.4%, 15 deaths vs. 7.5%, 12 deaths, P = 0.002); this difference was not observed in the matched cohort (19.1%, 9 deaths vs. 8.5%, 4 deaths, P = 0.14). Women more commonly undergo isolated replacement of the ascending aorta (78.7% vs. 59.6%, P < 0.001), whereas aortic root replacement is performed more frequently males (53.2% vs. 19.1%, P < 0.001). There is no significant difference in the incidence of major postoperative morbidity between sexes. Advanced age is associated with great 30-day mortality after ATAAD repair (OR 1.93). Conclusions: The significant difference in 30-day mortality observed in the overall cohort, was not observed in the matched cohort. This may suggest that the overall difference in outcomes with regards to sex, is secondary to the differences seen in age and presentation and not inherent to sex itself.