Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
Ann Thorac Surg. 2022 Apr;113(4):1153-1158. doi: 10.1016/j.athoracsur.2021.04.069. Epub 2021 May 7.
We investigated the relationship of sex with clinical outcomes after proximal aortic (ascending and arch) operations, and whether sex-specific preoperative factors are associated with mortality.
Of 3745 patients who underwent elective, urgent, and emergency proximal aortic operations over a 30-year period, 1153 pairs of men and women were propensity-matched, and their early and long-term outcomes were compared. Kaplan-Meier survival analysis was used to estimate late survival.
Women and men had similar operative mortality (9.1% vs 8.8%, P = .8), stroke (5.7% vs 5.6%, P = .9), and renal failure rates (7.0% vs 6.6%, P = .7). Thirty-day mortality was 7.5% vs 5.6% (P = .06), respectively. Results were less favorable for women than for men regarding respiratory failure (34.3% vs 29.2%, P=0.008) and intensive care unit length of stay (9.11 ± 11.9 vs 7.87 ± 12.48 days; P = .023). Long-term survival was not significantly different between women and men: 66.3% (95% confidence interval [CI] 62.8%-69.5%) vs 67.1% (95% CI 63.6%-70.4%) at 5 years, and 45.9% (95% CI 41.76%-50.0%) vs 46.2% (95% CI 41.7%-50.6%) at 10 years (P = .4). Preoperative factors including diabetes, prior stroke, prior renal insufficiency, and peripheral vascular disease were associated with operative mortality in men, whereas chronic obstructive pulmonary disease was the main risk factor in women.
No differences were seen between the sexes in life-changing adverse outcomes after ascending aortic and arch procedures, although specific preoperative variables were associated with specific adverse events. Recognizing differences in preoperative risk factors for mortality between the sexes may facilitate targeted preoperative assessment, preparation, and counseling.
我们研究了性别与近端主动脉（升主动脉和弓部）手术后临床结果之间的关系，以及性别特异性术前因素是否与死亡率相关。
在 30 年期间，对 3745 例行择期、紧急和急诊近端主动脉手术的患者进行了研究，其中 1153 对男女患者进行了倾向匹配，并比较了他们的早期和长期结果。采用 Kaplan-Meier 生存分析法估计晚期生存率。
女性和男性的手术死亡率相似（9.1%比 8.8%，P=0.8）、卒中发生率相似（5.7%比 5.6%，P=0.9）和肾衰竭发生率相似（7.0%比 6.6%，P=0.7）。30 天死亡率分别为 7.5%和 5.6%（P=0.06）。女性的呼吸衰竭发生率（34.3%比 29.2%，P=0.008）和重症监护病房住院时间（9.11±11.9 比 7.87±12.48 天；P=0.023）均高于男性。女性和男性的长期生存率无显著差异：5 年时分别为 66.3%（95%可信区间[CI] 62.8%-69.5%）和 67.1%（95% CI 63.6%-70.4%），10 年时分别为 45.9%（95% CI 41.76%-50.0%）和 46.2%（95% CI 41.7%-50.6%）（P=0.4）。在男性中，糖尿病、既往卒中、既往肾功能不全和外周血管疾病等术前因素与手术死亡率相关，而慢性阻塞性肺疾病是女性的主要死亡风险因素。
在升主动脉和弓部手术后，改变生活的不良结局在性别之间没有差异，尽管特定的术前变量与特定的不良事件相关。认识到性别间死亡率的术前危险因素的差异可能有助于有针对性地进行术前评估、准备和咨询。
