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.
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.
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).
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.
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
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Thoracic and Cardiovascular Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Acute aortic dissection type A: age-related management and outcomes reported in the german registry for acute aortic dissection type A (GERAADA) of over 2000 patients.Ann Surg. 2014; 259: 598-604
- German registry for acute aortic dissection type A: structure, results, and future perspectives.J Thorac Cardiovasc Surg. 2017; 65: 77-84
- Gender-related differences in acute aortic dissection.Circulation. 2004; 109: 3014-3021
- German registry for acute aortic dissection type A (GERAADA)—new software design, parameters and their definitions.J Thorac Cardiovasc Surg. 2011; 59: 69-77
- Gender differences in patients undergoing surgery for acute type A aortic dissection.J Thorac Cardiovasc Surg. 2015; 150: 581-587.e1
- Correlation between sex and prognosis of acute aortic dissection in the Chinese population.Chin Med J (Engl). 2018; 131: 1430-1435
- Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD).J Am Coll Cardiol. 2004; 43: 665-669
- GenTAC registry report: gender differences among individuals with genetically triggered thoracic aortic aneurysm and dissection.Am J Med Genet A. 2013; 161: 779-786
- Gender-related changes in aortic geometry throughout life.Eur J Cardiothorac Surg. 2014; 45: 805-811
- Influence of contraceptive and other sex steroids on aortic collagen and elastin.Exp Mol Pathol. 1980; 33: 1524
- Hormonal therapy increases arterial compliance in postmenopausal women.J Am Coll Cardiol. 1997; 30: 350-356
- Effect of hormone replacement therapy on non-invasive cardiovascular haemodynamics.J Hypertens. 1997; 15: 987-993
- 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC).Eur Heart J. 2014; 35: 2873-2926
- Gender-specific differences in outcome of ascending aortic aneurysm surgery.PLoS One. 2015; 10: e0124461
- Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection.Ann Thorac Surg. 2014; 98: 582-588
- Aortic stiffness in adolescent Turner and Marfan syndrome patients.Eur J Cardiothorac Surg. 2018; 54: 926-932
- Type A aortic dissection in Marfan syndrome: extent of initial surgery determines long-term outcome.Circulation. 2014; 129: 1381-1386
- Operative techniques in patients with type A dissection complicated by cerebral malperfusion.Eur J Cardiothorac Surg. 2014; 46: 156-166
- Surgical outcomes of aortic repair via transapical cannulation and the adventitial inversion technique for acute Type A aortic dissection.Eur J Cardiothorac Surg. 2018; 54: 369-374
- A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection.Eur J Cardiothorac Surg. 2019; 55: 201-209
- Outcomes of valve-sparing root replacement in acute Type A aortic dissection.Eur J Cardiothorac Surg. 2018; 53: 1021-1026
- The fate of the downstream aorta after open aortic repair for acute DeBakey type I aortic dissection: total arch replacement with elephant trunk technique versus non-total arch replacement.Eur J Cardiothorac Surg. 2019; 55: 966-974
- Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: results from an international multicentre registry.Eur J Cardiothorac Surg. 2017; 52: 310-318
- True-lumen and false-lumen diameter changes in the downstream aorta after frozen elephant trunk implantation.Eur J Cardiothorac Surg. 2018; 54: 375-381
Published online: November 27, 2019
Accepted: November 19, 2019
Received in revised form: November 15, 2019
Received: July 25, 2019
© 2019 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirectAccess this article on ScienceDirect
- 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.
- 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.
- 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.