IP157. Impact of Gender and Ethnicity on Survival After Thoracoabdominal Repair

Abstract

Female gender and nonwhite race have been implicated as risk factors for cardiovascular disease mortality. We examined cardiovascular risk factors, along with gender and race, in patients with descending or thoracoabdominal aortic aneurysm (DTAA/TAAA) to determine whether these additional considerations influence outcome beyond traditional risk factors. We reviewed our DTAA/TAAA repairs between 2000 and 2014. Baseline characteristics, presentation, in-hospital, and long-term outcomes were compared by gender. Univariate and multivariable analyses were conducted by standard methods and Kaplan-Meier and Cox regression for long-term survival. Of 1180 DTAA/TAAA patients (age 64.2 ± 14.1 years), 374 (31.7%) were females. Women were older (65 vs 63 years; P < .025) with worse baseline renal function (eGFR 70.3 vs 82.6 mL/min/1.73m2; P < .001) than men. History of CAD (24% vs 34%; P < .001), prior ascending repair (26% vs 20%; P < .014), aortic dissection (27% vs 41%; P < .001), and prior abdominal aortic repair (10% vs 21%; P < .001) were lower in women. Women had more symptomatic presentation (72% vs 66%; P < .031), TAAA-extent 1 (15% vs 11%; P <.029), TAAA-extent 3 (13% vs 9%; P = .05) and TAAA-extent 5 (8% vs 5%; P < .019). Intraoperatively, they had shorter clamp (44 vs 51 minutes; P < .001) and pump (53 vs 62 minutes; P < .001) times and less cryoprecipitate use (15 vs 17 units; P < .03). In multivariable analysis, female gender was not significantly predictive of 30-day mortality, but white race was associated with decreased 30-day mortality-risk (30% reduced odds; P < .05). Over a median follow-up of 4 (IQR 0.3-8.1) years, 10-year survival was significantly lower in women (42% vs 48%; P < .043). Multiple Cox regression analysis demonstrated age 67 to 74 years (P < .02), age >74 years (P < .001), GFR <60 (P < .001), CAD (P < .001), COPD (P < .02), pump time (P < .001), percentage postoperative decrease in GFR (P < .001), ruptured presentation (P < .001), peripheral vascular disease (P < .01), redo operation (P < .004), and cerebrovascular disease (P < .001) independently increased overall mortality risk. Women did not live longer than men after adjustment for other significant covariates. Women with DTAA/TAAA were older, with lower GFR, but had less overall cardiovascular disease burden and had shorter operative times. Our results indicate that while women and men have similar early outcomes, nonwhites may have some survival disadvantage. The observed significantly lower 30-day mortality in whites might suggest some effect of socioeconomic status. Although women had worse unadjusted long-term survival, we did not identify any significant effect on mortality attributable to female gender or race.