Abstract
The aim of this study was to improve insight into male-female differences in patients undergoing ascending aortic aneurysm surgery. Consecutive patients that underwent ascending aortic aneurysm surgery between January 1991-December 2016 were retrospectively analyzed. Patient and procedural characteristics, 30-day mortality, and survival were compared between male and female patients. Multivariable Cox-regression analysis was performed to explore differences in factors associated with long-term mortality. Of 631 included patients, 36% were female patients. They were older (66 (55.9-72.9) vs 56 (44.1-67.3) years, p < 0.001), had a higher logistic EuroSCORE (12 (8-17) vs 8 (5-12), p < 0.001), and underwent concomitant arch surgery more often (74% vs 54%, p < 0.001). Aortic diameter (5.5 (5.0.6.5) vs 5.5 (5.0-6.0) cm, p=0.025) and Aortic Size Index (3.15 (2.80-3.65) vs 2.70 (2.42-3.00) cm/m2, p < 0.001) were larger in female patients. Early mortality was 0.9% in female patients and 2.0% in male patients (p=0.51). Adjusted 15-year survival was comparable between male and female patients. Multivariable Cox-regression did not identify an independent association between female sex and mortality. In males a larger aortic diameter (HR1.38 per centimeter increase, 95%-CI 1.03-1.85, p=0.003) was an independent factor associated with mortality, and in female patients a larger BSA (HR0.08 per 1kg/m2 increase, 95%-CI 0.01-0.49, p=0.007) was an independent risk-reducing factor. Female patients presented at older age and with more advanced disease. Increased awareness for ascending aortic pathology and timely referral may result in better preoperative profiles in female patients. This may improve outcomes after ascending aortic aneurysm surgery.
Highlights
The exact incidence of thoracic aortic aneurysm (TAA) is unknown because it is often asymptomatic [1]
Female patients presented at older age and with more advanced disease
Increased awareness for ascending aortic pathology and timely referral may result in better preoperative profiles in female patients
Summary
The exact incidence of thoracic aortic aneurysm (TAA) is unknown because it is often asymptomatic [1]. Untreated aortic aneurysms can lead to aortic dissections or ruptures, with high morbidity and mortality[3]. In this regard, research into male-female differences in thoracic aortic diseases is scarce. Female patients with abdominal aortic aneurysms have a faster aortic growth rate[12] and a higher risk of rupture[13]. Both the physiological and the psychological differences between male and female patients render the possibility of differences in (determinants of) outcomes[14]. The aim of this study was to investigate male-female differences in patient and procedural characteristics, perioperative morbidity, and short- and long-term mortality in patients undergoing elective ascending aortic aneurysm surgery
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