Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2022 Dec;37(12):4342-4347. doi: 10.1111/jocs.16988. Epub 2022 Oct 2.
While prior data have suggested worse outcomes in women after acute type A aortic dissection (ATAAD) repair when compared to men, results have been inconsistent across studies over time. This study sought to evaluate the impact of sex on short- and long-term outcomes after ATAAD repair.
This was a retrospective study utilizing an institutional database of ATAAD repairs from 2007 to 2021. Patients were stratified according to sex. Kaplan-Meier survival estimation and multivariable Cox regression were performed. Supplementary analysis using propensity score matching was also performed.
Of the 601 patients who underwent ATAAD repair, 361 were males (60.1%) and 240 (39.9%) were females. Females were significantly older, more likely to have hypertension, and more likely to have chronic lung disease. Females were also significantly more likely than males to undergo hemiarch replacement, while males were significantly more likely than females to undergo total arch replacement and frozen elephant trunk. Operative mortality was 9.4% among males and 13.8% among females, though this was not a statistically significant difference (p = .098). Postoperative complications were comparable between groups. Kaplan-Meier survival estimates were similar for men and women, and, on multivariable Cox regression, sex was not significantly associated with long-term survival (hazard ratio: 1.00, 95% confidence interval: 0.73, 1.37, p = .986). Outcomes remained comparable after supplementary propensity score matched analysis.
ATAAD repair can be performed with comparable short-term and long-term outcomes in both men and women.
虽然先前的数据表明，与男性相比，女性在急性 A 型主动脉夹层（ATAAD）修复后预后更差，但随着时间的推移，不同研究的结果并不一致。本研究旨在评估性别对 ATAAD 修复后短期和长期结果的影响。
这是一项回顾性研究，利用 2007 年至 2021 年机构 ATAAD 修复数据库。根据性别对患者进行分层。采用 Kaplan-Meier 生存估计和多变量 Cox 回归进行分析。还进行了倾向评分匹配的补充分析。
在 601 例接受 ATAAD 修复的患者中，361 例为男性（60.1%），240 例（39.9%）为女性。女性年龄较大，更有可能患有高血压和慢性肺部疾病。女性接受半弓置换术的可能性明显高于男性，而男性接受全弓置换术和冷冻象鼻的可能性明显高于女性。男性的手术死亡率为 9.4%，女性为 13.8%，但差异无统计学意义（p=0.098）。两组术后并发症相当。Kaplan-Meier 生存估计在男性和女性之间相似，多变量 Cox 回归显示，性别与长期生存无显著相关性（风险比：1.00，95%置信区间：0.73，1.37，p=0.986）。补充倾向评分匹配分析后结果仍然相似。
男女均可进行 ATAAD 修复，短期和长期结果相当。
