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.