DISCUSSION
This single-center study compares sex-based outcomes of ATAAD repair.
There were no significant differences in operative mortality or
long-term survival between men and women. Rates of postoperative stroke,
renal failure requiring dialysis, and re-exploration for bleeding were
also comparable between groups. Because of the differences in baseline
characteristics and operative variables between the two groups, we also
performed supplementary propensity-score matched analyses, which yielded
comparable results.
Our findings differ from those of many prior studies which suggest worse
outcomes in women. A single-center study of 400 patients in China
demonstrated higher in-hospital mortality and higher rates of
in-hospital complications such as myocardial ischemia, hypoxemia, and
tamponade in women with ATAAD when compared to men [13]. Another
study from the International Registry of Acute Aortic Dissection (IRAD)
database in 2004 demonstrated that women, while less likely than men to
develop ATAAD, were more likely to present later in life, to have
complications such as rupture and tamponade, to have worse surgical
outcomes, and to have higher in-hospital mortality than men with ATAAD
[5].
Placing our findings in the context of prior studies, perhaps the
differences can be explained by a reduction of sex-related disparities
in outcomes over time. Indeed, a more recent query of the IRAD database
demonstrated significantly higher in-hospital mortality for women with
ATAAD when compared to men overall, but not within the last decade of
enrollment, suggesting that disparity in sex-based outcomes may be
improving with time [14]. Like ours, this study also demonstrated
that females with ATAAD presented later in life than males did, and that
males were more likely overall to undergo total arch and elephant trunk
procedures. Consistent with our study’s findings, a meta-analysis
published in 2022 demonstrates comparable short-term mortality and
postoperative outcomes between men and women after ATAAD repair
[15], and another 2022 study using the Taiwan National Health
Insurance Research database found no significant sex-related differences
in in-hospital mortality or all-cause mortality between men and women
undergoing ATAAD repair [16].
Our study did find a significant association with African American race
and risk of mortality (Table 4), with a higher hazard ratio than any
other variable in the model, including presence of malperfusion. This
suggests that, while we may have come a long way with improving
sex-related disparities in outcomes, we still have considerable work to
do in mitigating race-related disparities.