Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

Raphaelle A. Chemtob; Vibeke Hjortdal; Anders Ahlsson; Jarmo Gunn; Ari Mennander; Igor Zindovic; Christian Olsson; Aldina Pivodic; Emma C. Hansson; Anders Jeppsson; Arnar Geirsson; Tomas Gudbjartsson

doi:10.1055/s-0039-1687900

AORTA, Table of Contents

CC BY 4.0 · Aorta (Stamford) 2019; 07(01): 007-014
DOI: 10.1055/s-0039-1687900

Original Research Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

Raphaelle A. Chemtob

¹Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio

,

Vibeke Hjortdal

²Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark

,

Anders Ahlsson

³Heart and vascular theme, Karolinska University Hospital, Stockholm, Sweden

,

Jarmo Gunn

⁴Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland

,

Ari Mennander

⁵Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland

,

Igor Zindovic

⁶Department of Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden

⁷Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden

,

Christian Olsson

³Heart and vascular theme, Karolinska University Hospital, Stockholm, Sweden

,

Aldina Pivodic

⁸Statistiska Konsultgruppen, Gothenburg, Sweden

,

Emma C. Hansson

⁹Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

¹⁰Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

,

Anders Jeppsson

⁹Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

¹⁰Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

,

Arnar Geirsson

¹¹Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut

,

Tomas Gudbjartsson

¹²Department of Cardiothoracic Surgery, Landspitali University Hospital, Hringbraut, Reykjavik, Iceland

› Author Affiliations

Abstract

Background Female sex is known to have increased perioperative mortality in cardiac surgery. Studies reporting effects of sex on outcome following surgical repair for acute Type A aortic dissection (ATAAD) have been limited by small cohorts of heterogeneous patient populations and have shown diverging results. This study aimed to compare perioperative characteristics, operative management, and postoperative outcome between sexes in a large and well-defined cohort of patients operated for ATAAD.

Methods The Nordic Consortium for Acute Type A Aortic Dissection study included patients with surgical repair of ATAAD at eight Nordic centers between January 2005 and December 2014. Independent predictors of 30-day mortality were identified using multivariable logistic regression.

Results Females represented 373 (32%) out of 1,154 patients and were significantly older (65 ± 11 vs. 60 ± 12 years, p < 0.001), had lower body mass index (25.8 ± 5.4 vs. 27.2 ± 4.3 kg/m², p < 0.001), and had more often a history of hypertension (59% vs. 48%, p = 0.001) and chronic obstructive pulmonary disease (8% vs. 4%, p = 0.033) compared with males. More females presented with DeBakey class II as compared with males with dissection of the ascending aorta alone (33.4% vs. 23.1%, p = 0.003). Hypothermic cardiac arrest time (28 ± 16 vs. 31 ± 19 minutes, p = 0.026) and operation time (345 ± 133 vs. 374 ± 135 minutes, p < 0.001) were shorter among females. There was no difference between the sexes in unadjusted intraoperative death (9.1% vs. 6.7%, p = 0.17) or 30-day mortality (17.7% vs. 17.4%, p = 0.99). In a multivariable analysis including perioperative factors influencing mortality, no difference was found between females and males in 30-day mortality (odds ratio: 0.92, 95% confidence interval: 0.62–1.38, p = 0.69).

Conclusions This study found no association between sex and early mortality following surgery for ATAAD, despite females being older and having more comorbidities, yet also presenting with a less widespread dissection than males.

Keywords

aortic dissection - aortic operation - outcomes - surgery - complications - sex

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Supplementary Material