Abstract
BackgroundAlthough gender-related disparities in cardiovascular surgery have been investigated extensively in the past decades, knowledge about the impact of gender on outcomes after surgery for acute aortic dissection type A (AADA) is sparse. This study investigated the impact of gender on early morbidity and mortality and follow-up outcome in patients after surgery for AADA and to analyze gender-related risk factors for 30-day mortality.MethodsThis retrospective study included 368 consecutive patients (male 65.8% vs. female 34.2%) undergoing surgery for AADA between 2001 and 2016 at our department. Survival was estimated by Kaplan-Meier curves. Risk factors for 30-day mortality were assessed by multivariable logistic regression and interaction analysis.ResultsWomen were older (70.7 years vs. 60.6 years; p < 0.001) and showed a higher logistic EuroSCORE I (31.0% vs. 19.7%, p < 0.001). In the male group, a higher portion of smokers (27.6% vs. 16.0%, p = 0.015) and intraoperatively, more complex procedures and longer cardiopulmonary bypass (CPB) (171 min vs. 149 min, p = 0.001) and cross-clamping times (94 min vs. 85 min, p = 0.018) occurred. 30-day mortality was 19.0% in the female and 16.5% in the male group (p = 0.545). Predictive for 30-day mortality in both genders was intraoperative blood transfusion, while in the female group chronic obstructive pulmonary disease (COPD), peripheral arterial disease and preoperative intubation were predictive. Preoperative cardiopulmonary resuscitation and duration of CPB time were predictors only in males. Averaged follow-up time was 5.2 years and survival did not differ between genders, even if it was stratified by age over 70 years.ConclusionsThis analysis demonstrated a similar and satisfactory survival in both genders after surgical treatment of AADA. Women and men differed significantly in age, unadjusted and adjusted risk factors and complexity of surgical treatment, but gender itself was no risk factor for mortality. These results suggest that the decision-making for surgical treatment should not depend on gender, but that accounting for sex-specific risk factors rather than common risk factors may help to improve the outcome in both genders.
Highlights
Gender-related disparities in cardiovascular surgery have been investigated extensively in the past decades, knowledge about the impact of gender on outcomes after surgery for acute aortic dissection type A (AADA) is sparse
Men are affected by AADA about twice as often compared to the incidence in women and present at younger age [2,3,4] and with considerable differences in comorbidities and risk factors [5,6,7]
AADA was defined as any dissection of the aortic wall with a clear entry site or intramural hematoma involving the ascending aorta or with an entry in the descending aorta with retrograde dissection
Summary
Gender-related disparities in cardiovascular surgery have been investigated extensively in the past decades, knowledge about the impact of gender on outcomes after surgery for acute aortic dissection type A (AADA) is sparse. As in coronary disease, delayed presentation and diagnosis in women due to less typical pain, older age and different comorbidities were described as potential risk factors for a worse outcome in female patients after surgery for AADA [2, 5]. In contrast to these findings, female gender was not associated with a worse outcome in recent studies [3, 4, 12, 13]. Several studies on the risk factors for mortality after surgery for AADA included gender as risk factor [4, 14], but information about sex-specific risk factors of women and men is rare
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