Female Sex Is Not an Independent Risk Factor for Poor Prognosis of Patients with Acute Type A Aortic Dissection Undergoing Surgery

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiac Surgery Pub Date : 2023-06-02 DOI:10.1155/2023/8889261

Chenyu Zhou, Jinlin Wu, E. Xie, L. Dai, Jian Song, R. Zhao, Shiqi Gao, J. Qiu, Cuntao Yu

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Abstract

Background and Aim of the Study. The effects of sex on the prognosis of patients with acute type A aortic dissection (ATAAD) have still remained controversial. This study aimed to explore the sex differences in outcomes of ATAAD patients undergoing surgery. Methods. Data of patients with ATAAD who were operated in our center from 2010 to 2018 were retrospectively collected. Data on pre-, intra-, and postoperative courses were analyzed. Propensity score weighting was performed to balance the baseline characteristics. Multivariable logistic regression was used to assess predictors of early mortality in overall female and male patients. Results. A total of 1448 patients were enrolled, including 352 (24.3%) female patients and 1096 (75.7%) male patients. Females were significantly older than males (56.0 vs. 47.8 years, P < 0.001 ). Dissection was less extensive (Fuwai Ct: 85.8% vs. 91.3%, P = 0.003 ) and malperfusion syndrome was less frequently diagnosed (Penn Ab: 19.3% vs. 29.7%, P < 0.001 ) in females. Males experienced more aortic root replacement (Bentall: 14.2% vs. 24.9%, P < 0.001 ) and total arch replacement combined with frozen elephant trunk (56.8% vs. 75.8%, P < 0.001 ) with the prolonged operation time (6.1 vs. 6.4 hours, P = 0.001 ). In contrast, early mortality was higher in females (9.4% vs. 6.1%, P = 0.036 ). No differences were found in long-term survival and reoperation rates. After propensity score weighting, sex suggested no influence on both early and long-term outcomes. Cardiopulmonary bypass time was an independent risk factor for early mortality in both overall and sex-related populations according to the multivariable logistic regression. Conclusions. In ATAAD, different presentations and surgical strategies were noted in male and female patients. However, there were no significant differences in early and long-term outcomes between sexes after propensity score weighting.

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女性不是急性A型主动脉夹层手术患者预后不良的独立危险因素

研究背景和目的。性别对急性A型主动脉夹层(ATAAD)患者预后的影响仍存在争议。本研究旨在探讨ATAAD患者手术预后的性别差异。方法。回顾性收集2010 - 2018年在我中心手术的ATAAD患者资料。分析术前、术中和术后病程的数据。倾向得分加权来平衡基线特征。多变量逻辑回归用于评估女性和男性患者早期死亡率的预测因素。结果。共纳入1448例患者，其中女性352例(24.3%)，男性1096例(75.7%)。女性明显大于男性(56.0岁比47.8岁，P < 0.001)。女性夹层较少(Fuwai Ct: 85.8% vs. 91.3%， P = 0.003)，灌注不良综合征的诊断较少(Penn Ab: 19.3% vs. 29.7%， P < 0.001)。随着手术时间的延长(6.1小时比6.4小时，P = 0.001)，男性主动脉根部置换术(Bentall: 14.2%比24.9%，P < 0.001)和全弓置换术联合冷冻象鼻(56.8%比75.8%，P < 0.001)的发生率更高。相比之下，女性的早期死亡率更高(9.4%比6.1%，P = 0.036)。两组的长期生存率和再手术率均无差异。在倾向评分加权后，性别对早期和长期结果都没有影响。根据多变量logistic回归，体外循环时间是整体人群和性别相关人群早期死亡的独立危险因素。结论。在ATAAD中，男性和女性患者的表现和手术策略不同。然而，在倾向得分加权后，两性之间的早期和长期结果没有显著差异。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.