Gökalp Arjen L, Thijssen Carlijn G E, Bekkers Jos A, Roos-Hesselink Jolien W, Bogers Ad J J C, Geuzebroek Guillaume S C, Houterman Saskia, Takkenberg Johanna J M, Mokhles Mostafa M
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Ann Cardiothorac Surg. 2023 Nov 27;12(6):577-587. doi: 10.21037/acs-2022-adw-fs-0139. Epub 2023 Jun 27.
Scientific research regarding male-female differences in ascending aortic surgery is scarce. The objective of this study was to identify male-female differences in presentation, treatment and peri-operative outcome in elective ascending aortic surgery.
Elective ascending aortic surgery procedures that took place in the Netherlands between 01/01/2013-31/12/2017 were identified from the Netherlands Heart Registration. Male-female differences in presentation, treatment characteristics, and in-hospital mortality and morbidity were explored.
The study population consisted of 887 females (31%) and 1,972 males (69%). Females were older (median age 67 versus 62 years, P<0.001), more often had chronic lung disease (12.3% versus 9.1%, P=0.011), New York Heart Association (NYHA) class III-IV (21.5% versus 15.5%, P=0.003), and less often a history of percutaneous coronary intervention (PCI) (3.2% versus 5.0%, P=0.033). Isolated supracoronary aortic replacement was performed in 47.7% of females versus 30.6% of males (P<0.001), and ascending aorta with root replacement in 40.6% of females versus 56.7% of males (P<0.001). Females more often underwent concomitant interventions of the aortic arch (33.1% versus 20.2%, P<0.001) and the mitral valve (8.2% versus 5.2%, P=0.002), and less often concomitant coronary artery bypass grafting (CABG) (14.4% versus 19.1%, P=0.002). Overall, in-hospital mortality was significantly higher in females (5.1% versus 2.7%, P=0.003). In multivariable regression analysis, being female was an independent risk factor for in-hospital mortality [odds ratio (OR) 1.55, 95% confidence interval (CI): 1.02-2.37].
This nation-wide cohort shows clear differences between females and males in patient presentation, procedural characteristics, in-hospital outcomes, and risk factors for in-hospital mortality in elective ascending aortic surgery. Further exploration of these differences, and of modifiable within-male and within-female risk factors, may offer great opportunities in improving treatment and thereby outcomes for both males and females.
关于升主动脉手术中男女差异的科学研究较少。本研究的目的是确定择期升主动脉手术中男女在临床表现、治疗及围手术期结果方面的差异。
从荷兰心脏注册中心识别出2013年1月1日至2017年12月31日在荷兰进行的择期升主动脉手术。探讨了男女在临床表现、治疗特征以及住院死亡率和发病率方面的差异。
研究人群包括887名女性（31%）和1972名男性（69%）。女性年龄更大（中位年龄67岁对62岁，P<0.001），慢性肺病发生率更高（12.3%对9.1%，P=0.011），纽约心脏协会（NYHA）III-IV级发生率更高（21.5%对15.5%，P=0.003），经皮冠状动脉介入治疗（PCI）史发生率更低（3.2%对5.0%，P=0.033）。47.7%的女性进行了单纯冠状动脉上主动脉置换，而男性为30.6%（P<0.001）；40.6%的女性进行了升主动脉根部置换，而男性为56.7%（P<0.001）。女性更常接受主动脉弓（33.1%对20.2%，P<0.001）和二尖瓣（8.2%对5.2%，P=0.002）的同期干预，而冠状动脉旁路移植术（CABG）同期干预较少（14.4%对19.1%，P=0.002）。总体而言，女性的住院死亡率显著更高（5.1%对2.7%，P=0.003）。在多变量回归分析中，女性是住院死亡率的独立危险因素[比值比（OR）1.55，95%置信区间（CI）：1.02-2.37]。
这个全国性队列显示，在择期升主动脉手术中，男女在患者表现、手术特征、住院结局以及住院死亡率危险因素方面存在明显差异。进一步探索这些差异以及男性和女性内部可改变的危险因素，可能为改善治疗从而改善男女的治疗结果提供巨大机会。
