Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective
Frederike Meccanici, BSc,
Carlijn G.E. Thijssen, MD, PhD,
Arjen L. Gökalp, MD,
Marie H.E.J. van Wijngaarden, MD,
Mark F.A. Bierhuizen, MD,
Guy F. Custers, MD,
Jort Evers, BSc,
Jolien A. de Veld, MD,
Maximiliaan L. Notenboom, BSc,
Guillaume S.C. Geuzebroek, MD, PhD,
Joost F.J. ter Woorst, MD, PhD,
Jelena Sjatskig, MD,
Robin H. Heijmen, MD, PhD,
Mostafa M. Mokhles, MD, PhD,
Roland R.J. van Kimmenade, MD, PhD,
Jos A. Bekkers, MD, PhD,
Johanna J.M. Takkenberg, MD, PhD,
Jolien W. Roos-Hesselink, MD, PhD
Affiliations
Frederike Meccanici, BSc
Department of Congenital Cardiology, Erasmus MC, Rotterdam, The Netherlands
Carlijn G.E. Thijssen, MD, PhD
Department of Congenital Cardiology, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiothoracic Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
Arjen L. Gökalp, MD
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
Marie H.E.J. van Wijngaarden, MD
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
Mark F.A. Bierhuizen, MD
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
Guy F. Custers, MD
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
Jort Evers, BSc
Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
Jolien A. de Veld, MD
Department of Congenital Cardiology, Erasmus MC, Rotterdam, The Netherlands
Maximiliaan L. Notenboom, BSc
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
Guillaume S.C. Geuzebroek, MD, PhD
Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
Joost F.J. ter Woorst, MD, PhD
Department of Cardiothoracic Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
Jelena Sjatskig, MD
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
Robin H. Heijmen, MD, PhD
Department of Cardiothoracic Surgery, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
Mostafa M. Mokhles, MD, PhD
Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
Roland R.J. van Kimmenade, MD, PhD
Department of Congenital Cardiology, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiothoracic Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
Jos A. Bekkers, MD, PhD
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
Johanna J.M. Takkenberg, MD, PhD
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
Jolien W. Roos-Hesselink, MD, PhD
Department of Congenital Cardiology, Erasmus MC, Rotterdam, The Netherlands; Address for reprints: Jolien W. Roos-Hesselink, MD, PhD, Department of Congenital Cardiology, Erasmus MC, Rg-419, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Background: Male–female differences in clinical presentation, management, and outcomes of acute type A aortic dissection (AD-A) have been reported; however, robust data are scarce. This study examined those differences. Methods: Consecutive adults diagnosed with AD-A between 2007 and 2017 in 4 referral centers were included retrospectively. Baseline data, operative characteristics, and mortality and morbidity during follow-up were collected using patient files, questionnaires, and referral information. Results: The study included 889 patients (37.5% female). Females were significantly older at presentation (median, 67.0 [interquartile range [IQR], 59.0-75.0] years vs 61.0 [IQR, 53.0-69.0] years; P < .001) and more often had cardiovascular comorbidities. Severe hypotension, tamponade, and nausea were more frequently observed in females. Short-term mortality was 18.5% in females and 21.2% in males (P = .362). No significant differences in treatment between males and females were observed. After surgery, the median follow-up was 6.2 years (IQR, 3.5-9.2 years). Overall 10-year survival was 50.1% (95% confidence interval [CI], 43.6%-57.6%) in females and 62.8% (95% CI, 58.1%-67.9%) in males (P = .009), although this difference was not significant after multivariable correction. Compared to the matched general population, survival was lower than expected in females and comparable to expected in males. The long-term reintervention rate in surgically treated survivors was comparable between males and females (2.1%/patient-year). Male- and female-specific risk factors for long term mortality were identified. Conclusions: These findings highlight a distinct clinical profile at presentation with AD-A between males and females, while treatment approach and short-term mortality were comparable. The relatively poor long-term survival in females and male-/female-specific risk stratification warrant further investigation.
