Women Experience Higher Rates of Mortality Following Thoracic Endovascular Aneurysm Repair.

BACKGROUND

Thoracic endovascular aortic repair (TEVAR) and complex endovascular thoraco-abdominal aneurysm repair have been increasingly adopted in the treatment of thoracic and thoracoabdominal aorta aneurysms, offering a less invasive approach for patients with appropriate anatomy. Women usually present with smaller aortic diameter. However, they usually have greater aneurysm growth rates. How sex can affect postoperative and short-term outcomes after TEVAR is not well reported. The aim of this study was to assess outcomes in female versus male patients undergoing TEVAR for treatment of thoracic and thoracoabdominal aneurysms in a Medicare-linked database.

METHODS

We retrospectively reviewed patients undergoing TEVAR for thoracic and thoracoabdominal aneurysm repair in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database from 2003 to 2018. Patients were divided into males and females. Patients presented with ruptured aneurysm were excluded from the analysis. Postoperative outcomes included in-hospital stroke, myocardial infarction, spinal cord ischemia, and 30-day mortality. One-year outcomes included mortality, aneurysmal rupture, and reintervention. Postoperative outcomes were assessed using multivariable logistic regression analysis and 1-year outcomes were evaluated using Kaplan-Meier Survival and Cox regression analyses.

RESULTS

A total of 3,058 males and 1,843 females were available for the analysis. Female patients had smaller median aortic diameter, were more likely to be Black, with chronic obstructive pulmonary disease, and chronic kidney disease, and to be symptomatic on presentation. Male patients were more likely to be on preoperative medications such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, P2Y12 antagonists, and anticoagulants. After adjusting for potential confounders, female gender was associated with double the risk of in-hospital stroke (odds ratio: 2.3, 95% confidence interval [CI] [1.5-3.7], P < 0.001) and 80% increase in 30-day mortality (odds ratio: 1.8, 95% CI [1.3-2.6], P = 0.001). At 1 year, female gender was associated with a higher risk of mortality (hazard ratio: 1.2, 95% CI [1.05-1.4], P = 0.011). There was a trend toward higher risk of reintervention (hazard ratio: 1.2, 95% CI [0.97-1.6], P = 0.079).

CONCLUSIONS

Mortality after TEVAR seems to be higher in female patients at 30 days and up to 1 year of follow-up. Female patients also face a 2 times higher risk of in-hospital stroke. Future studies with a larger female population should aim to identify and potentially ameliorate the factors associated with these unfavorable outcomes in females.