The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery.

BACKGROUND

Older age and female sex are thought to be risk factors for adverse outcomes after repair of acute type A aortic dissection (AAAD). The aim of this study is to analyze age- and sex-related outcomes in patients undergoing AAAD repair.

METHODS

Retrospective analysis of patients undergoing emergency AAAD repair. Patients were divided in Group A, patients aged ≥75 years and Group B <75. Intraoperative and postoperative data were compared between groups before and after propensity score matching. Sex differences were analyzed by age group.

RESULTS

Between January 2006 and December 2018, 638 patients underwent emergency AAAD repair. Group A included 143 patients (22.4%), Group B 495 (77.6%). More patients in Group A presented with circulatory collapse (Penn C 26.6% 9.7%, P=0.001) while Group B presented with circulatory collapse-branch malperfusion (Penn BC 29.3% 15.4% P=0.001). After propensity score matching, Group B patients received more complex aortic root (33.6% 23.2%, P=0.019) and concomitant bypass surgery (12.3% 6.3%, P=0.042). There was no significant difference in in-hospital mortality between age groups (18% 12% P=0.12). In Group B, in-hospital mortality was significantly higher in females (22.2% 8.2%, P=0.028). Differences in mortality disappeared after the age of 75 (18.3% 19.4% P=0.87).

CONCLUSIONS

Morbidity and mortality are comparable between patients under and over 75 years after AAAD repair. Female patients <75 had higher in-hospital mortality than their male counterparts.