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Gender-related differences in patients with acute aortic dissection type A

Published:November 27, 2019DOI:https://doi.org/10.1016/j.jtcvs.2019.11.039

      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

      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)
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      Linked Article

      • Dissecting sex and gender
        The Journal of Thoracic and Cardiovascular SurgeryVol. 160Issue 2
        • Preview
          With 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
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        Open Archive
      • Commentary: Gender and outcomes of acute aortic dissection: Instantaneously good, but then?
        The Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 2
        • Preview
          Since 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
        • PDF
      • Commentary: Gender differences in aortic pathology and detection bias
        The Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 2
        • Preview
          Health 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
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