Female Sex Is Not an Independent Risk Factor for Poor Prognosis of Patients with Acute Type A Aortic Dissection Undergoing Surgery

Abstract

Background and Aim of the Study. The effects of sex on the prognosis of patients with acute type A aortic dissection (ATAAD) have still remained controversial. This study aimed to explore the sex differences in outcomes of ATAAD patients undergoing surgery. Methods. Data of patients with ATAAD who were operated in our center from 2010 to 2018 were retrospectively collected. Data on pre-, intra-, and postoperative courses were analyzed. Propensity score weighting was performed to balance the baseline characteristics. Multivariable logistic regression was used to assess predictors of early mortality in overall female and male patients. Results. A total of 1448 patients were enrolled, including 352 (24.3%) female patients and 1096 (75.7%) male patients. Females were significantly older than males (56.0 vs. 47.8 years, $P<0.001$ ). Dissection was less extensive (Fuwai Ct: 85.8% vs. 91.3%, $P=0.003$ ) and malperfusion syndrome was less frequently diagnosed (Penn Ab: 19.3% vs. 29.7%, $P<0.001$ ) in females. Males experienced more aortic root replacement (Bentall: 14.2% vs. 24.9%, $P<0.001$ ) and total arch replacement combined with frozen elephant trunk (56.8% vs. 75.8%, $P<0.001$ ) with the prolonged operation time (6.1 vs. 6.4 hours, $P=0.001$ ). In contrast, early mortality was higher in females (9.4% vs. 6.1%, $P=0.036$ ). No differences were found in long-term survival and reoperation rates. After propensity score weighting, sex suggested no influence on both early and long-term outcomes. Cardiopulmonary bypass time was an independent risk factor for early mortality in both overall and sex-related populations according to the multivariable logistic regression. Conclusions. In ATAAD, different presentations and surgical strategies were noted in male and female patients. However, there were no significant differences in early and long-term outcomes between sexes after propensity score weighting.