Disparities in Outcomes Between Sexes in Type B Aortic Dissection Patients Treated with TEVAR

Abstract

To evaluate differences in presentation and outcomes between sexes in patients who underwent thoracic endovascular aortic repair for type B aortic dissection (TBAD). Between January 1, 2012 and January 1, 2017 186 patients underwent thoracic endovascular aortic repair for TBAD at a single institution. Men (n=112) and women (n=74) were compared based on presenting demographics, comorbidities, and postoperative complications. Primary outcomes were survival and need for reintervention. Women were older (P=0.04) and had a lower body mass index (P=0.03). More women (F) presented with continued pain or refractory hypertension (51.0% F, 30.0% M), while more men (M) presented with acute complicated dissections (19.0% F, 39.0% M) (P=0.008). At presentation, women had statistically higher relative rates of chronic obstructive pulmonary disease (P=0.05), hyperlipidemia (P=0.03), and smoking (P=0.03). Significantly more women were on Medicare without Medicaid (55.0% F, 34.0% M), while men had private insurance (35.0% F, 13.0% M) (P=0.005). There was no significant difference in blood pressure control at presentation, discharge, or at 30days. When normalized by body surface area, women had larger ascending aortic diameters (19.2(3.10)F, 17.5(2.40)M, P=0.0002), as well as proportionally larger true lumens at the left subclavian artery (14.9(2.90)F, 13.4(2.50)M, P=0.0002), carina (12.6(5.80)F, 9.90(4.80)M, P=0.0009), and celiac (10.5(4.50)F, 8.50(4.10)M, P=0.006) levels, and at the largest point of dissection (11.6(6.50)F, 9.60(4.80)M, P=0.04), as well as proportionately smaller false lumens at the carina (5.90(5.60)F, 9.30(6.10)M, P=0.003). Despite not being statistically significant, women had lower rates of stroke (6.80% F, 8.00% M, P=0.7) and acute kidney injury (5.40% F, 11.6% M, P=0.2), as well fewer days in the intensive care unit (ICU) (3.20(4.30)F, 4.60(6.60)M, P=0.2) and an overall shorter length of stay (6.80(6.70)F, 8.00(8.20)M, P=0.5). Kaplan-Meier estimates for survival for women versus men were 96.0% vs. 92.0%, 90.0% vs. 79.0%, and 70.0% vs. 69.0% at 30 days, 1 year, and 3 years, respectively (P=0.042). Kaplan-Meier estimates for freedom from reintervention for women versus men were 89.0% vs. 90.0%, 58.0% vs. 72.0%, and 48.0% vs. 58.0% at 30 days, 1 year, and 3 years, respectively (P=0.13). Women present with TBAD at an older age, have more comorbidities, lower socioeconomic status, and have larger ascending aortic diameters for their size. Despite having less severe dissections as evidenced by smaller false lumens and wider true lumens, it does not appear that this correlates with improved outcomes for women when compared to men. It appears that this is one of the few, if not only, aortic pathologies that result in comparable outcomes between sexes.