Gender-Related Differences in Patients with Acute Aortic Dissection Type A

Objectives: 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, fifty-six centers participating in the German Registry for Acute Aortic Dissection Type A (GERAADA) reported on a total of 3,380 patients. As many as 1,234 (37%) were female and 2,146 (63%) were male. We compared their clinical features and events occurring within 30 days after surgery with descriptive measures and appropriate tests (unpaired Student’s t-test, Mann-Whitney U-test or chi-squared test). The influence of gender on the 30-day mortality was analyzed using a logistic mixed effect model with random effect for center to account for center heterogeneity.

Results: Women were significantly older than male patients (65.5 ± 12.7 vs. 59.2 ± 13.3 years, < p < 0.001). Aortic dissection extended down to the abdominal aorta in 43% men and 39% women (p = 0.01). Visceral (4.9 vs. 7.3%, p = 0.006) and renal malperfusion (7.7 vs. 10.6%, p = 0.006) were more frequently diagnosed in men. Aortic roots were replaced more frequently in men (22 vs. 18%, < p < 0.001). Different aortic-arch repair strategies were distributed similarly in both genders. Both genders' incidence of new hemiplegia or hemiparesis was also similar (p = 0.24). Thirty-day mortality did not differ between women and men (16.3 vs. 16.6%, p = 0.18). In a logistically mixed-effect model, gender revealed no influence on 30-day mortality (OR: 1.15, CI 95%: 0.92–1.44, p = 0.21).

Conclusion: 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.