An Analysis of Perioperative Risk Factors for Long Term Survival after Surgery for Acute Type A Dissection Focusing on Gender-specific Differences

Abstract

We focused on gender specific perioperative risk factors for the survival of an acute Stanford type A aortic dissection. A cohort of 147 patients undergoing surgery since 2004 was studied in a 9 year follow-up. Analysis was performed using Cox-proportional hazard model focusing on 36 variables. Survival after 1y (5, 10y) was 98% (88%, 50%). Early mortality was 25%, 27% female, with a higher age (+10y, mean, 64±10y) than men. In the 7th decade, percentage of women was as twofold higher and threefold higher in the 8th decade. Survival probability (Log rank test) for the first postoperative year was 0.82/0.77 (female/male) for 5 years 0.70/0.71, and 0.46/ 0.50 for 10 years. Risk factor analysis showed women having a high hazard ratio for death in case of resternotomy (16.543), bleeding (8.1), and renal insufficiency (3.4). Only EURO-Score (1.103, p=0.038) and length of hospital stay (0.849, p=0.015) were significant risk factors for death. The survival curve declines between 5 and 10 years (88% to 50%). In male patients, age and resternotomy had a significant influence on survival. Women had a higher incidence for aortic type a dissection in the 7th and 8th decades. Gender did not influence survival.