性别对急性A型主动脉夹层修复术后早期结局的影响：北欧急性A型主动脉夹层联盟（NORCAAD）的研究结果
Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD).
作者信息
Chemtob Raphaelle A, Hjortdal Vibeke, Ahlsson Anders, Gunn Jarmo, Mennander Ari, Zindovic Igor, Olsson Christian, Pivodic Aldina, Hansson Emma C, Jeppsson Anders, Geirsson Arnar, Gudbjartsson Tomas
机构信息
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark.
出版信息
Aorta (Stamford). 2019 Feb;7(1):7-14. doi: 10.1055/s-0039-1687900. Epub 2019 Jul 22.
BACKGROUND
Female sex is known to have increased perioperative mortality in cardiac surgery. Studies reporting effects of sex on outcome following surgical repair for acute Type A aortic dissection (ATAAD) have been limited by small cohorts of heterogeneous patient populations and have shown diverging results. This study aimed to compare perioperative characteristics, operative management, and postoperative outcome between sexes in a large and well-defined cohort of patients operated for ATAAD.
METHODS
The Nordic Consortium for Acute Type A Aortic Dissection study included patients with surgical repair of ATAAD at eight Nordic centers between January 2005 and December 2014. Independent predictors of 30-day mortality were identified using multivariable logistic regression.
RESULTS
Females represented 373 (32%) out of 1,154 patients and were significantly older (65 ± 11 vs. 60 ± 12 years, < 0.001), had lower body mass index (25.8 ± 5.4 vs. 27.2 ± 4.3 kg/m, < 0.001), and had more often a history of hypertension (59% vs. 48%, = 0.001) and chronic obstructive pulmonary disease (8% vs. 4%, = 0.033) compared with males. More females presented with DeBakey class II as compared with males with dissection of the ascending aorta alone (33.4% vs. 23.1%, = 0.003). Hypothermic cardiac arrest time (28 ± 16 vs. 31 ± 19 minutes, = 0.026) and operation time (345 ± 133 vs. 374 ± 135 minutes, < 0.001) were shorter among females. There was no difference between the sexes in unadjusted intraoperative death (9.1% vs. 6.7%, = 0.17) or 30-day mortality (17.7% vs. 17.4%, = 0.99). In a multivariable analysis including perioperative factors influencing mortality, no difference was found between females and males in 30-day mortality (odds ratio: 0.92, 95% confidence interval: 0.62-1.38, = 0.69).
CONCLUSIONS
This study found no association between sex and early mortality following surgery for ATAAD, despite females being older and having more comorbidities, yet also presenting with a less widespread dissection than males.
背景
已知女性在心脏手术中的围手术期死亡率较高。关于性别对急性A型主动脉夹层（ATAAD）手术修复后结局影响的研究，因患者群体异质性且队列规模较小而受到限制，结果也存在分歧。本研究旨在比较在一大群明确界定的接受ATAAD手术的患者中，不同性别之间的围手术期特征、手术管理及术后结局。
方法
北欧急性A型主动脉夹层联盟研究纳入了2005年1月至2014年12月期间在八个北欧中心接受ATAAD手术修复的患者。使用多变量逻辑回归确定30天死亡率的独立预测因素。
结果
1154例患者中，女性有373例（32%），年龄显著更大（65±11岁对60±12岁，P<0.001），体重指数更低（25.8±5.4对27.2±4.3kg/m²，P<0.001），与男性相比，有高血压病史（59%对48%，P=0.001）和慢性阻塞性肺疾病史（8%对4%，P=0.033）的情况更常见。与仅升主动脉夹层的男性相比，更多女性表现为DeBakey II型（33.4%对23.1%，P=0.003）。女性的低温心脏停搏时间（28±16分钟对31±19分钟，P=0.026）和手术时间（345±133分钟对374±135分钟，P<0.001）更短。未经调整的术中死亡率（9.1%对6.7%，P=0.17）或30天死亡率（17.7%对17.4%，P=0.99）在性别之间无差异。在一项纳入影响死亡率的围手术期因素的多变量分析中，女性和男性在30天死亡率方面无差异（比值比：0.92，95%置信区间：0.62 - 1.38，P=0.69）。
结论
本研究发现，ATAAD手术后性别与早期死亡率之间无关联，尽管女性年龄更大、合并症更多，但夹层范围也比男性小。
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