Abstract
ObjectiveThe aim of this study is to evaluate the sex-related differences on the risks of perioperative and late outcomes for adult acute aortic dissection (AAD) patients following surgical management.Methods and resultsBy using Taiwan National Health Insurance Research Database, totally 1,410 female and 3,432 male patients were identified to first-ever receive type A AAD open surgery or type B AAD stenting treatment from 2004 to 2013. We assessed the sex-related difference on outcomes, including in-hospital mortality, all-cause mortality, aortic death, redo aortic surgery, ischemic stroke, and depression during the follow-up period. The analysis was done separately for type A and type B surgeries.ResultsOn average, female patients diagnosed with AAD were older than males. There was no significant sex difference of in-hospital mortality or all-cause mortality for both type A open and type B stent surgeries. The risk of redo aortic surgery was significantly greater in males than females (7.8% vs. 4%; unadjusted subdistribution hazard ratio [SHR] 0.51, 95% CI 0.38–0.69) for type A open surgery, but not for type B stent surgery. Noticeably, the risk of newly-diagnosed depression was significantly greater in females than males (8% vs. 5.1%; unadjusted SHR 1.6, 95% CI 1.24–2.06) for type A open surgery, but not for type B stent surgery.ConclusionsNo significant sex-related difference was found for the in-hospital mortality or accumulative all-cause mortality. However, there were more redo aortic surgeries for males and more postoperative depression for females in type A AAD population.
Highlights
Acute aortic dissection (AAD) is a life-threatening disease with high morbidity and mortality rates, requiring timely treatment
The risk of redo aortic surgery was significantly greater in males than females (7.8% vs. 4%; unadjusted subdistribution hazard ratio [SHR] 0.51, 95% CI 0.38– 0.69) for type A open surgery, but not for type B stent surgery
No significant sex-related difference was found for the in-hospital mortality or accumulative all-cause mortality
Summary
Acute aortic dissection (AAD) is a life-threatening disease with high morbidity and mortality rates, requiring timely treatment. Based on an observational analysis from the International Registry of Acute Aortic Dissections (IRAD), approximately two-thirds (67%) of patients were diagnosed with type A, and the remaining as type B AAD. The patients in both types of AAD were predominantly men; the outcome of female patients was worse [1]. Few studies have indicated differences in demographics, clinical manifestation, diagnostic vascular imaging, managements, and outcomes between the sexes [2,3,4]. The difference of incidence for depression between the sexes had been reported in patients with post-acute coronary syndrome [7]
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