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Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study

Background: Type A Acute Aortic Dissection (TAAAD) repair is a surgical emergency associated with high morbidity and mortality. Registry data have noted several sex-specific differences in presentation with TAAAD which may account for the differences in men and women undergoing surgery for this cond...

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Autores principales: Nappi, Francesco, Petiot, Sandra, Salsano, Antonio, Avtaar Singh, Sanjeet Singh, Berger, Joelle, Kostantinou, Marisa, Bonnet, Severine, Gambardella, Ivancarmine, Biancari, Fausto, Almazil, Almothana, Santini, Francesco, Chaara, Rim, Fiore, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10143202/
https://www.ncbi.nlm.nih.gov/pubmed/37103025
http://dx.doi.org/10.3390/jcdd10040147
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author Nappi, Francesco
Petiot, Sandra
Salsano, Antonio
Avtaar Singh, Sanjeet Singh
Berger, Joelle
Kostantinou, Marisa
Bonnet, Severine
Gambardella, Ivancarmine
Biancari, Fausto
Almazil, Almothana
Santini, Francesco
Chaara, Rim
Fiore, Antonio
author_facet Nappi, Francesco
Petiot, Sandra
Salsano, Antonio
Avtaar Singh, Sanjeet Singh
Berger, Joelle
Kostantinou, Marisa
Bonnet, Severine
Gambardella, Ivancarmine
Biancari, Fausto
Almazil, Almothana
Santini, Francesco
Chaara, Rim
Fiore, Antonio
author_sort Nappi, Francesco
collection PubMed
description Background: Type A Acute Aortic Dissection (TAAAD) repair is a surgical emergency associated with high morbidity and mortality. Registry data have noted several sex-specific differences in presentation with TAAAD which may account for the differences in men and women undergoing surgery for this condition. Methods: A retrospective review of data from three departments of cardiac surgery (Centre Cardiologique du Nord, Henri-Mondor University Hospital, San Martino University Hospital, Genoa) between January 2005 and 31 December 2021 was conducted. Confounders were adjusted using doubly robust regression models, a combination of regression models with inverse probability treatment weighting by propensity score. Results: 633 patients were included in the study, of which 192 (30.3%) were women. Women were significantly older with reduced haemoglobin levels and pre-operative estimated glomerular filtration rate compared to men. Male patients were more likely to undergo aortic root replacement and partial or total arch repair. Operative mortality (OR 0.745, 95% CI: 0.491–1.130) and early postoperative neurological complication results were comparable between the groups. The adjusted survival curves using IPTW by propensity score confirmed the absence of a significant impact of gender on long-term survival (HR 0.883, 95% CI 0.561–1.198). In a subgroup analysis of women, preoperative levels of arterial lactate (OR 1.468, 95% CI: 1.133–1.901) and mesenteric ischemia after surgery (OR 32.742, 95% CI: 3.361–319.017) were significantly associated with increased operative mortality. Conclusions: The advancing age of female patients alongside raised preoperative level of arterial lactate may account for the increasing preponderance among surgeons to perform more conservative surgery compared to their younger male counterparts although postoperative survival was similar between the groups.
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spelling pubmed-101432022023-04-29 Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study Nappi, Francesco Petiot, Sandra Salsano, Antonio Avtaar Singh, Sanjeet Singh Berger, Joelle Kostantinou, Marisa Bonnet, Severine Gambardella, Ivancarmine Biancari, Fausto Almazil, Almothana Santini, Francesco Chaara, Rim Fiore, Antonio J Cardiovasc Dev Dis Article Background: Type A Acute Aortic Dissection (TAAAD) repair is a surgical emergency associated with high morbidity and mortality. Registry data have noted several sex-specific differences in presentation with TAAAD which may account for the differences in men and women undergoing surgery for this condition. Methods: A retrospective review of data from three departments of cardiac surgery (Centre Cardiologique du Nord, Henri-Mondor University Hospital, San Martino University Hospital, Genoa) between January 2005 and 31 December 2021 was conducted. Confounders were adjusted using doubly robust regression models, a combination of regression models with inverse probability treatment weighting by propensity score. Results: 633 patients were included in the study, of which 192 (30.3%) were women. Women were significantly older with reduced haemoglobin levels and pre-operative estimated glomerular filtration rate compared to men. Male patients were more likely to undergo aortic root replacement and partial or total arch repair. Operative mortality (OR 0.745, 95% CI: 0.491–1.130) and early postoperative neurological complication results were comparable between the groups. The adjusted survival curves using IPTW by propensity score confirmed the absence of a significant impact of gender on long-term survival (HR 0.883, 95% CI 0.561–1.198). In a subgroup analysis of women, preoperative levels of arterial lactate (OR 1.468, 95% CI: 1.133–1.901) and mesenteric ischemia after surgery (OR 32.742, 95% CI: 3.361–319.017) were significantly associated with increased operative mortality. Conclusions: The advancing age of female patients alongside raised preoperative level of arterial lactate may account for the increasing preponderance among surgeons to perform more conservative surgery compared to their younger male counterparts although postoperative survival was similar between the groups. MDPI 2023-03-30 /pmc/articles/PMC10143202/ /pubmed/37103025 http://dx.doi.org/10.3390/jcdd10040147 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nappi, Francesco
Petiot, Sandra
Salsano, Antonio
Avtaar Singh, Sanjeet Singh
Berger, Joelle
Kostantinou, Marisa
Bonnet, Severine
Gambardella, Ivancarmine
Biancari, Fausto
Almazil, Almothana
Santini, Francesco
Chaara, Rim
Fiore, Antonio
Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study
title Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study
title_full Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study
title_fullStr Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study
title_full_unstemmed Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study
title_short Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study
title_sort sex-based difference in aortic dissection outcomes: a multicenter study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10143202/
https://www.ncbi.nlm.nih.gov/pubmed/37103025
http://dx.doi.org/10.3390/jcdd10040147
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