Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex.
Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Surgical Research Core, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2017 Oct;154(4):1203-1214.e6. doi: 10.1016/j.jtcvs.2017.05.089. Epub 2017 Jun 3.
Women fare worse than men after many cardiovascular operations, including coronary artery bypass grafting and valve surgery. We sought to determine whether sex affects outcomes after open thoracoabdominal aortic aneurysm repair.
We evaluated data on 3353 consecutive patients (1281 women, 38.2%) who underwent open thoracoabdominal aortic aneurysm repair between October 1986 and July 2015. We compared preoperative characteristics, surgical variables, and outcomes between men and women in the overall group. A propensity-matching analysis was performed to adjust for preoperative and intraoperative differences. A multivariable analysis was conducted to identify predictors of poor outcomes using relevant preoperative and intraoperative factors.
Men had a significantly higher prevalence of comorbid conditions, including coronary artery disease, and presented more often with dissection; women were slightly older than men (median age, 69 [62-74] years vs 67 [57-73] years; P < .001) and more often symptomatic. Men underwent extent II and IV repairs more often, whereas women more often had extent I and III repairs. The propensity analysis resulted in 958 matched pairs. Overall, women and men had similar early mortality (7.9% vs 7.2%, P = .5) and adverse event rates (14.8% vs 14.1%, P = .6), which were similar in propensity-matched groups. Multivariable analysis showed that predictors of operative death and adverse event differed between the sexes. Survival and freedom from repair failure were similar between the overall and matched groups.
Men and women who undergo thoracoabdominal aortic aneurysm repair have similar outcomes, but there are important differences in several perioperative factors and predictors of poor outcomes.
在许多心血管手术中，包括冠状动脉旁路移植术和瓣膜手术，女性的预后不如男性。我们试图确定性别是否会影响开放胸腹主动脉瘤修复的结果。
我们评估了 1986 年 10 月至 2015 年 7 月期间连续 3353 例接受开放胸腹主动脉瘤修复的患者（女性 1281 例，38.2%）的数据。我们比较了整体组中男性和女性的术前特征、手术变量和结果。采用倾向匹配分析调整术前和术中差异。采用多变量分析，使用相关的术前和术中因素确定不良结局的预测因素。
男性更常见合并症，包括冠状动脉疾病，并且更常表现为夹层；女性比男性稍大（中位数年龄，69[62-74]岁比 67[57-73]岁；P<0.001），且更常出现症状。男性更常进行 II 期和 IV 期修复，而女性更常进行 I 期和 III 期修复。倾向分析产生了 958 对匹配对。总体而言，女性和男性的早期死亡率（7.9%比 7.2%，P=0.5）和不良事件发生率（14.8%比 14.1%，P=0.6）相似，在匹配组中也相似。多变量分析显示，手术死亡和不良事件的预测因素在性别之间存在差异。总体和匹配组的生存和免于修复失败率相似。
接受胸腹主动脉瘤修复的男性和女性具有相似的结果，但在几个围手术期因素和不良结局的预测因素方面存在重要差异。
