Gender-related presentation, surgical treatment, outcome and failure to rescue after surgery for type A aortic dissection: results from a multicentre registry.

Abstract

Reports on gender-related differences in perioperative characteristics and the outcome after surgery for type A acute aortic dissection are contradictory. Perioperative characteristics, outcome and overall or itemized failure-to-rescue rates were collected retrospectively and dichotomized by gender in patients operated on at 5 referral institutions. A propensity score matched analysis was performed to compared males and females with similar preoperative risk profiles. Multivariable analysis assessed gender-related predictors of 30-day mortality. A total of 1271 patients were collected. Females (on average, 63 years old) developed type A acute aortic dissection, with differences in clinical presentation (number of intimal tears, thoracic pain at the onset of symptoms). Female-reported characteristics included lower frozen elephant trunk and elephant trunk procedures, higher femoral perfusion, retrograde cerebral perfusion and retrograde cardiopulmonary bypass restart after deep hypothermic circulatory arrest (P < 0.05). The 30-day mortality was 19.8%, without a gender-related difference (P = 0.37). No substantial differences in hospital outcome and in items related to failure to rescue were reported. A total of 256 propensity score matched pairs of males and females were investigated. Previous differences in surgical techniques and strategies were still confirmed; however, a higher incidence of postoperative permanent coma (P = 0.02) was reported in the female population. Different surgical techniques and operative strategies were used on the 2 genders, with a lower complexity in females. However, there were no differences in hospital outcome between genders, except for the higher incidence of coma in female patients.