Gender Differences in Acute Type A Aortic Dissection

Objectives: Acute type A aortic dissection (AAD) is a life-threatening disease. No differences between men and women have been made in the treatment of AAD so far and little is known about gender differences. This study aims to compare the short and long-term results of men and women after surgical treatment of AAD.

Methods: Between Jume 2004 and June 2018, a total of 636 patients were operated for AAD. Patients were identified and retrospectively analyzed for their demographics, comorbidities, operative details, postoperative course, short- and long-term outcomes. Mean age was 63.9 ± 13.7 years, 230/636 (36.2%) were women, and 406/636 (63.8%) were men.

Results: Mean age was significantly higher in women compared to men (67.9 ± 13.5 vs 61.6 ± 13.3, p < 0.001). Significantly less DeBakey Type I AAD was found in women (63.04 vs. 73.64%, p = 0.005). Comorbidities and preoperative status at the time of presentation were similar in women and men. Although similar malperfusion rates were found, men demonstrated a significantly higher rate of coronary malperfusion (6.08 vs. 11.57%, p = 0.024). Bicuspid aortic valve (0.87 vs. 4.92%, p = 0.007) and aortic valve insufficiency > II° (69.13 vs. 76.6%, p = 0.039) were more frequently found in men. The in-hospital mortality rate was similar in women and men (10.0 vs. 11.33%, p = 0.604). Ten-year survival rates of in-hospital survivors were significantly lower in women compared to men (51.9 vs. 72.8%, p = 0.007). Subgroup analysis of different age groups (>76 years, n = 121; 55–75 years, n = 283; < 55 years, n = 163) demonstrated superior long-term outcome for women >76 years (57 vs. 15%, p = 0.016). Similar outcome between men and women aged 55 to 76 years (61 vs 75%, p = 0.194) and inferior outcome for women younger than 55 years (82 vs. 91%, p = 0.027) was found.

Conclusions: Although women with AAD are significantly older and significant differences of the extent of the dissection as well as the aortic valve pathologies were found between women and men, in-hospital mortality and short-term outcome are similar. The difference in long-term survival is not due to the higher age of women at the time of surgery, a subgroup analysis of older patients showed a better survival of older women and similar survival of middle-aged women. Especially women under 55 years of age are at risk after AAD. This effect could be caused due to the hormonal situation in younger female patients or the existence of primary connective tissue diseases and should be considered during close follow-up.