Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany.
J Cardiothorac Surg. 2024 Jun 14;19(1):331. doi: 10.1186/s13019-024-02646-6.
Women undergoing cardiac surgery have been historically recognized to carry higher periprocedural mortality risk. We aimed to investigate the influence of sex on clinical presentation, perioperative, and long-term outcomes in patients who undergo surgery for ascending aortic aneurysm.
We conducted a retrospective review of 1148 consecutive patients (380 [33.1%] female) who underwent thoracic aortic surgery under moderate hypothermic circulatory arrest for ascending aortic aneurysms between 2001 and 2021. Baseline and operative characteristics, in-hospital mortality, and survival were compared between male and female patients before and after propensity-score-matched (PSM) analysis.
Women were significantly older (median age: 69 [IQR: 63-75] vs. 67 [IQR: 58-73]; P < 0.001), while men had a higher prevalence of aortic valve stenosis, bicuspid valve and coronary artery disease at the time of surgery (P < 0.05). After PSM, EuroSCORE II (4.36 [2.68; 6.87] vs. 3.22 [1.85; 5.31]; p < 0.001), and indexed aortic diameter were significantly higher in female patients (2.94 [2.68; 3.30] vs. 2.58 [2.38; 2.81] cm/m2, p < 0.001). In the matched cohort, men were more likely to experience postoperative delirium (18.1% vs. 11.5%; P = 0.002), and postoperative neurological deficits (6.7% vs. 3.0%, P = 0.044),. Female patients were more likely to receive postoperative packed red blood cells (p = 0.036) and fresh frozen plasma (p = 0.049). In-hospital and 30-day mortality was similar between both groups. Long-term survival was comparable between both groups with 88% vs. 88% at 5 years, 76% vs. 71% at 10 years, and 59% vs. 47% at 15 years.
Female patients required more transfusions, while males had a higher incidence of postoperative delirium and neurological deficits. Differences in preoperative age and timing of surgery between the sexes could be attributed to variations in comorbidity profiles and the greater prevalence of concomitant surgery indications in males.
接受心脏手术的女性历来被认为围手术期死亡率风险更高。我们旨在研究性别对接受升主动脉瘤手术的患者的临床特征、围手术期和长期结局的影响。
我们对 2001 年至 2021 年间接受中度低温体外循环下升主动脉瘤手术的 1148 例连续患者（380 例[33.1%]为女性）进行了回顾性分析。在进行倾向评分匹配（PSM）分析之前和之后，比较了男性和女性患者的基线和手术特征、住院死亡率和生存率。
女性患者明显更年长（中位数年龄：69 [IQR：63-75] vs. 67 [IQR：58-73]；P<0.001），而男性患者在手术时更常见主动脉瓣狭窄、二叶瓣和冠状动脉疾病（P<0.05）。PSM 后，女性患者的 EuroSCORE II（4.36 [2.68；6.87] vs. 3.22 [1.85；5.31]；p<0.001）和索引主动脉直径明显更高（2.94 [2.68；3.30] vs. 2.58 [2.38；2.81] cm/m2，p<0.001）。在匹配队列中，男性更有可能发生术后谵妄（18.1% vs. 11.5%；P=0.002）和术后神经功能缺损（6.7% vs. 3.0%，P=0.044）。女性患者更有可能接受术后浓缩红细胞（p=0.036）和新鲜冷冻血浆（p=0.049）。两组患者的住院死亡率和 30 天死亡率相似。两组患者的长期生存率相当，5 年时分别为 88%和 88%，10 年时分别为 76%和 71%，15 年时分别为 59%和 47%。
女性患者需要更多的输血，而男性患者术后谵妄和神经功能缺损的发生率更高。性别之间的术前年龄和手术时机差异可能归因于合并症谱的变化和男性中更常见的同时手术指征。
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