Institute for Biomedical Engineering and Nano Science, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, and Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2). doi: 10.1093/icvts/ivac068.
Presentation, management and outcomes in the aortic dissection (AD) of ascending thoracic aortic aneurysm (ATAA) differ in gender and age. The purpose of this study is to investigate the dissection properties of male and female ATAAs.
Peeling tests were performed to quantitatively determine the delamination strength and dissection energy of 41 fresh ATAA samples (22 males and 19 females) in relatively young (≤65 years) and elderly (>65 years) patients. The delamination strength of the ATAAs was further correlated with patient ages for males and females. The histological investigation was employed to characterize the dissected morphology.
For elderly patients, circumferential and longitudinal delamination strengths of the female ATAAs were statistically significantly lower than those of the males (circumferential: 31 ± 6 vs 42 ± 6 mN/mm, P < 0.01; longitudinal: 35 ± 7 vs 49 ± 10 mN/mm, P = 0.02). No significant differences were found in the delamination strength between males and females for relatively young patients. The circumferential and longitudinal delamination strengths were significantly decreased and strongly correlated with patient ages for females. However, these correlations were not present in males. Dissection routes propagated in the aortic media to create ruptured surfaces for all specimens. Peeling tests of the male ATAAs generate rougher surfaces than females.
There is a higher propensity of AD occurrence for the elderly females as compared to males with matched ages. Surgeons should be cognizant of the risk of AD onset later in life, especially in females.
升主动脉瘤（ATAA）的胸主动脉夹层（AD）在男性和女性中的表现、处理和结局不同。本研究旨在探讨男性和女性 ATAA 的夹层特性。
对 41 个新鲜 ATAA 样本（22 名男性和 19 名女性）进行剥离测试，以定量确定相对年轻（≤65 岁）和老年（>65 岁）患者的分层强度和夹层能量。进一步将男性和女性的 ATAA 分层强度与患者年龄相关联。采用组织学研究来描述夹层形态。
对于老年患者，女性 ATAA 的周向和纵向分层强度明显低于男性（周向：31±6 对 42±6 mN/mm，P<0.01；纵向：35±7 对 49±10 mN/mm，P=0.02）。相对年轻患者中，男性和女性之间的分层强度没有差异。女性的周向和纵向分层强度明显降低，与患者年龄强烈相关。然而，这种相关性在男性中并不存在。夹层路径在主动脉中层传播，为所有标本创建破裂表面。男性 ATAA 的剥离测试产生的表面比女性更粗糙。
与年龄匹配的男性相比，老年女性发生 AD 的倾向更高。外科医生应该意识到生命后期 AD 发病的风险，尤其是女性。
