# Sex-Related Differences Between Patients Undergoing Surgery for Acute Type A Aortic Dissection

## TL;DR

This study found sex-related differences in patients undergoing surgery for aortic dissection, including age, symptoms, and surgical outcomes.

## Contribution

The study identifies sex-specific differences in acute type A aortic dissection patients and suggests a sex-based management strategy.

## Key findings

- Females were older and had longer time from onset to surgery compared to males.
- Males had better long-term survival rates than females at 10 years.
- Sex was not an independent predictor of early death after surgery.

## Abstract

Introduction

This study aimed to evaluate the sex-specific characteristics and surgical outcomes in patients with acute type A aortic dissection (ATAAD).

Materials and methods

We reviewed the surgical records of patients who underwent ATAAD repair at our institution between 2004 and 2020 (n=213).

Results

Of the 213 patients, 100 (46.9%) were male, and 113 (53.1%) were female. Males were younger than females (62.5 vs. 72.9 years, p<0.0001). Females had more nonspecific symptoms (p=0.04), more frequently developed ATAAD before noon (45.0% vs. 53.1%, p=0.01), and had a significantly longer time from onset to surgery (425.1 vs. 595.8 min, p=0.03). The ascending aorta was replaced more frequently in females than in males (54.5% vs. 72.8%, p<0.01). No significant difference was observed in the in-hospital mortality rate between males and females (9.0% vs. 10.6%, p=0.69). The multivariable logistic analysis demonstrated that being male was not an independent predictor of operative mortality (OR, 0.96; 95% CI, 0.18-5.21; p=0.96). At 10 years, males had significantly better long-term survival rates in the unadjusted cohort than females (79.4% vs. 55.9%, p=0.02).

Conclusions

Male sex was not an independent predictor of early death in patients with ATAAD after surgery, although significant differences were noted in terms of age, onset time, chief complaint, imaging findings, and surgical procedures. A sex-based management strategy involving specific differences should be considered to improve outcomes.