Friedrich Christine, Salem Mohamed Ahmed, Puehler Thomas, Hoffmann Grischa, Lutter Georg, Cremer Jochen, Haneya Assad
Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Hs. C, 24105, Kiel, Germany.
J Cardiothorac Surg. 2020 Jun 18;15(1):145. doi: 10.1186/s13019-020-01189-w.
Although 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.
This 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.
Women 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.
This 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.
尽管在过去几十年中对心血管手术中与性别相关的差异进行了广泛研究，但关于性别对急性A型主动脉夹层（AADA）手术后结局的影响的了解却很少。本研究调查了性别对AADA手术后患者早期发病率、死亡率和随访结局的影响，并分析了30天死亡率的性别相关危险因素。
这项回顾性研究纳入了2001年至2016年间在我科连续接受AADA手术的368例患者（男性占65.8%，女性占34.2%）。通过Kaplan-Meier曲线估计生存率。通过多变量逻辑回归和交互分析评估30天死亡率的危险因素。
女性年龄更大（70.7岁对60.6岁；p<0.001），且欧洲心脏手术风险评估系统I（EuroSCORE I）的逻辑评分更高（31.0%对19.7%，p<0.001）。在男性组中，吸烟者比例更高（27.6%对16.0%，p=0.015），并且在术中，手术更复杂，体外循环（CPB）时间更长（171分钟对149分钟，p=0.001）以及主动脉阻断时间更长（94分钟对85分钟，p=0.018）。女性组30天死亡率为19.0%，男性组为16.5%（p=0.545）。术中输血对两性的30天死亡率均有预测作用，而在女性组中，慢性阻塞性肺疾病（COPD）、外周动脉疾病和术前插管具有预测作用。术前心肺复苏和CPB时间仅在男性中是预测因素。平均随访时间为5.2年，即使按70岁以上年龄分层，两性的生存率也没有差异。
本分析表明，AADA手术治疗后两性的生存率相似且令人满意。男性和女性在年龄、未经调整和调整后的危险因素以及手术治疗的复杂性方面存在显著差异，但性别本身不是死亡的危险因素。这些结果表明，手术治疗的决策不应取决于性别，但考虑性别特异性危险因素而非常见危险因素可能有助于改善两性的结局。
