Toshihiro Fukui1, Minoru Tabata2, Satoshi Morita3, Shuichiro Takanashi4. 1. Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan. Electronic address: tfukui.cvs@gmail.com. 2. Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. 3. Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan. 4. Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Abstract
OBJECTIVES: The impact of gender on preoperative characteristics and postoperative outcomes in patients undergoing surgery for acute type A aortic dissection rarely has been investigated. METHODS: We reviewed the records of 504 patients (245 women and 259 men) who underwent surgery for acute type A aortic dissection between August 2006 and December 2013. Women were older (71.5 vs 59.7 years; P < .001) and smaller (body surface area 1.5 vs 1.9 m(2); P < .001) than men. Early and long-term outcomes were compared between men and women. RESULTS: Operative mortality (<30 days) was similar between the groups (4.5% vs 5.8%; P = .646). Multivariable logistic regression analysis demonstrated that myocardial ischemia (odds ratio [OR], 5.48; 95% confidence interval [CI], 2.00-15.00; P < .001), neurologic ischemia (OR, 6.64; 95% CI, 2.26-19.48; P < .001), and shock/tamponade (OR, 3.74; 95% CI, 1.49-9.40; P = .005) were independent predictors of operative mortality. At 5 years, there was no significant difference in survival between the groups (80.1% vs 89.3%; P = .067). Cox regression analysis demonstrated that myocardial ischemia (hazard ratio [HR], 2.40; 95% CI, 1.21-4.74; P = .012), nonprescription of beta-blockers at discharge (HR, 4.27; 95% CI, 2.43-7.50; P < .001), and nonprescription of angiotensin II receptor blockers at discharge (HR, 2.39; 95% CI, 1.14-5.01; P = .021) were independent predictors of late mortality. Female gender was not an independent predictor of operative and late mortality. CONCLUSIONS: There are no differences in early and long-term outcomes between male and female patients undergoing surgery for acute type A aortic dissection.
OBJECTIVES: The impact of gender on preoperative characteristics and postoperative outcomes in patients undergoing surgery for acute type A aortic dissection rarely has been investigated. METHODS: We reviewed the records of 504 patients (245 women and 259 men) who underwent surgery for acute type A aortic dissection between August 2006 and December 2013. Women were older (71.5 vs 59.7 years; P < .001) and smaller (body surface area 1.5 vs 1.9 m(2); P < .001) than men. Early and long-term outcomes were compared between men and women. RESULTS: Operative mortality (<30 days) was similar between the groups (4.5% vs 5.8%; P = .646). Multivariable logistic regression analysis demonstrated that myocardial ischemia (odds ratio [OR], 5.48; 95% confidence interval [CI], 2.00-15.00; P < .001), neurologic ischemia (OR, 6.64; 95% CI, 2.26-19.48; P < .001), and shock/tamponade (OR, 3.74; 95% CI, 1.49-9.40; P = .005) were independent predictors of operative mortality. At 5 years, there was no significant difference in survival between the groups (80.1% vs 89.3%; P = .067). Cox regression analysis demonstrated that myocardial ischemia (hazard ratio [HR], 2.40; 95% CI, 1.21-4.74; P = .012), nonprescription of beta-blockers at discharge (HR, 4.27; 95% CI, 2.43-7.50; P < .001), and nonprescription of angiotensin II receptor blockers at discharge (HR, 2.39; 95% CI, 1.14-5.01; P = .021) were independent predictors of late mortality. Female gender was not an independent predictor of operative and late mortality. CONCLUSIONS: There are no differences in early and long-term outcomes between male and female patients undergoing surgery for acute type A aortic dissection.
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