Gender differences in configuration and surgical treatment of ascending aortic aneurysms

Objectives: To determine the influence gender has on the configuration of ascending aortic aneurysms and their surgical treatment including early postoperative outcome.

Methods: Retrospective analysis of 614 consecutive patients (173 women, 67.5 ± 9.8 years; 441 men, 63.6 ± 11.7 years) who underwent surgery for aneurysms of the ascending aorta from 2003 to 2011.

Results: Women presented with larger aneurysms (57.0 ± 11.1 mm vs. 54.1 ± 8.5 mm, p = 0.013); and more frequently showed involvement of the aortic-arch (32.9% vs. 23.6%, p = 0.013), and supraaortic vessels (8.1% vs. 2.3%, p = 0.002). In men the aortic-root was more commonly affected (14.5% vs. 28.9%, p < 0.001). No differences were found in incidence and degree of aortic valve insuffiency (70.5% vs. 69.9%, p = 0.399). Aortic stenosis, however, was more common in men (39.9% vs. 49.9%, p = 0.016). Expectedly, surgery differed with hemi-arch repair in 26.2% women as compared to 16.7% in men (p = 0.006), conversely 33.3% composite (including valve) replacements in men but only 21.5% in women (p = 0.003). Operative treatment resulted in a lower 30-day-survival in women (91.7% vs. 95.9%, log-rank 4.1, p = 0.042). Logistic regression analysis indicated female sex (OR 2.18, p = 0.036), age (OR 1.64 calculated over a 5-year-time-interval, p < 0.001), arch enlargement (OR 2.54, p = 0.016), operating and cardiopulmonary bypass time (OR 1.52 and 2.17 calculated over 60-min-time-intervals, p < 0.001), total arch replacement (OR 4.19, p = 0.007), CABG (OR 2.89, p = 0.009), re-thoracotomy (OR 8.48, p < 0.001), postoperative elevated creatinine (OR 3.70, p = 0.002) and malperfusion (OR 11.96, p < 001) with a significant negative impact on 30-day-survival. Multivariate analysis demonstrated an even higher early mortality risk for female patients in comparison to male patients (30-day-mortality, adjusted for age, cardiopulmonary bypass time, re-thoracotomy and postoperative elevated creatinine, OR 3.84, 95% CI 1.29 – 11.41, p = 0.015).

Conclusions: Through retrospective analysis of female and male patients with surgical treatment for aneurysms of the ascending aorta gender differences are discernible. When counseling patients, these differences have to be considered and advice modified accordingly. In women the awareness for ascending aortic disease should be heightened in order to reduce operative risk.