Abstract
Objective
Acute aortic dissection type A can occur in both genders at any age. Our aim was to
report differences in presentation, treatment, and outcome in female and male patients
with acute aortic dissection type A.
Methods
Between July 2006 and June 2015, 56 centers participating in the German Registry for
Acute Aortic Dissection Type A reported on a total of 3380 patients. As many as 1234
(37%) were women and 2146 (63%) were men. We compared their clinical features and
events occurring within 30 days after surgery.
Results
Women were significantly older than male patients (65.5 ± 12.7 years vs 59.2 ± 13.3 years;
P < .001). Aortic dissection extended down to the abdominal aorta in 43% men and 39%
women (P = .01). Visceral (4.9% vs 7.3%; P = .006) and renal malperfusion (7.7% vs 10.6%; P = .006) were more frequently diagnosed in men. Aortic roots were replaced more frequently
in men (22% vs 18%; P < .001). Different aortic arch repair strategies were distributed similarly in both
genders. The incidence of new hemiplegia or hemiparesis was also similar in men and
women (P = .24). Thirty-day mortality did not differ between women and men (16.3% vs 16.6%;
P = .18). In a logistically mixed-effect model, gender revealed no influence on 30-day
mortality (odds ratio, 1.15; 95% confidence interval, 0.92-1.44; P = .21).
Conclusions
Aortic dissection type A occurs almost twice as frequently in men. Women develop aortic
dissection later in life. Despite women and men presenting at different ages and exhibiting
varying dissection and malperfusion patterns, and the fact that men undergo complex
proximal aortic repair more frequently, outcomes are similar in both genders.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
GERAADA (German Registry for Acute Aortic Dissection Type A), ICU (intensive care unit), IRAD (International Registry of Acute Aortic Dissections)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 27, 2019
Accepted:
November 19,
2019
Received in revised form:
November 15,
2019
Received:
July 25,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Dissecting sex and genderThe Journal of Thoracic and Cardiovascular SurgeryVol. 160Issue 2
- PreviewWith great interest, we read the study by Rylski and colleagues1 titled “Gender-Related Differences in Patients With Acute Aortic Dissection Type A,” published recently in the Journal. The topic of male–female differences in aortic disease remains underexplored, despite the increasing attention for sex and gender differences in cardiovascular research. The paper is therefore very much welcomed, well-written, and provides insightful data. However, we have one critical comment regarding the use of the word “gender” by the authors to indicate the male–female cohorts.
- Full-Text
- Preview
- Commentary: Gender and outcomes of acute aortic dissection: Instantaneously good, but then?The Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 2
- PreviewSince 2006, the GERAADA Registry has reflected the tendencies and outcomes in the practice of surgery for acute type A aortic dissection in many centers from Germany, Austria, Switzerland, and Luxembourg.1 It is the expression of a great deal of commitment and represents an invaluable source of information in a field that continues to offer challenges and gratification, surprises, and frustrations. The current prestigious manuscript issued from the GERAADA Registry written by Rylski and coworkers2 confirms that acute dissection tends to occur more frequently and earlier in life in men compared with women, underscores that men tend to present with a more severe proximal phenotype (with more frequent need for root replacement), and indicates that despite these dissimilarities, overall early outcomes are similar among genders.
- Full-Text
- Preview
- Commentary: Gender differences in aortic pathology and detection biasThe Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 2
- PreviewHealth inequality between genders is a well-known phenomenon that has been demonstrated for centuries, first documented in the 1850s by the British epidemiologist William Farr.1 Such differences are clearly demonstrated when comparing overall life expectancy, which has improved in females since the 1890s2; however, questions remain as to the contributing factors. In this edition of the Journal, Rylski and colleagues3 examine gender-related differences in acute aortic dissection, specifically differences in disease presentation, anatomic burden, and surgical outcomes.
- Full-Text
- Preview
