Gender Differences in Repair Strategy, Not Outcomes for Aortic Dissection Type A

Aortic dissection type A was found to occur twice as frequently in men vs women, with a later occurrence in women, but similar surgical outcomes for both genders, according to a study published in The Journal of Thoracic and Cardiovascular Surgery.

Researchers aimed to assess gender differences in clinical presentation and dissection patterns, as well as gender-based surgical treatment and outcomes for acute aortic dissection type A. Data were collected from the multicenter, prospective German Registry of Acute Aortic Dissection Type A (GERAADA) between July 2006 and June 2015. An online questionnaire was used to collect information on demographics, cardiovascular risks, diagnostic methods, clinical evaluations, surgery details, postoperative outcomes, and cause of death.

Of the 3380 patients included in this study, 63.5% were men. The average age of women was higher than that of men (65.5 years vs 59.2 years, respectively; P <.001), and men were more frequently diagnosed with hemiplegia/hemiparesis (P =.085) and paraplegia/paraparesis (P =.018) at admission. Visceral and renal malperfusions were more frequently observed in men (P =.006 for both), and men with Marfan syndrome were diagnosed twice as often as women with Marfan syndrome (P =.002). Descending thoracic aorta dissections and abdominal aorta dissections were more frequent in men vs women (P =.028 and P =.01, respectively), and dissections of all aortic segments down to the abdominal aorta were more frequent in younger patients (P =.076). Supracoronary ascending aortic replacement was more frequent in women (P <.001), and aortic root replacement by composite graft implantation or David surgery was more frequent in men (P <.001). There were no significant gender differences for outcomes, including 30-day morality (odds ratio, 1.15; 95% CI, 0.92-1.44; P =.21).

Study limitations include a lack of assessment of patients who died before treatment or were treated conservatively, and a short follow-up to assess outcomes (30-day). 

“This analysis highlights important differences in the clinical presentations of and surgical approaches to type A dissection in women and men,” noted the study authors. “Aortic dissection involves the entire aorta more frequently in men, and they experience visceral and renal malperfusion more frequently. Although the arch repair pattern was similar in both genders, men underwent complex aortic root repair or replacement more frequently.”  Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Rylski B, Georgieva N, Beyersdorf F, et al. Gender-related differences in patients with acute aortic dissection type A [published online November 27, 2019]. J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2019.11.039