Sex differences in acute type A aortic dissection: a systematic review and meta-analysis

Abstract

Introduction: The objective of this study is to provide a comprehensive comparison of outcomes following acute type A aortic dissection (ATAAD) repair in males and females.

Evidence acquisition: PubMed, Medline, and Web of Science were systematically searched by two authors for studies published from January 1^st, 2000, to May 10^th, 2021. Overall, 2405 articles were screened, and 16 were included in this review. Meta-analysis of the compiled data was performed.

Evidence synthesis: Pooled estimates indicated no difference in operative (odds ratio (OR) 1.00, 95% confidence interval (CI) 0.59-1.67, P=0.99, I²=52%), in-hospital (OR 0.78, 95% CI 0.56-1.08; P=0.13, I²=57%), and 30-day mortality (OR 1.09, 95% CI 0.83-1.43, P=0.52, I²=45%) between the sexes. However, males had significantly reduced 5-year mortality rates (OR 0.71, 95% CI 0.51-1.00, P=0.05, I²=45%). There was no difference between sexes in rates of postoperative stroke (OR 1.07, 95% CI 0.86-1.33, P=0.54, I²=0%), atrial fibrillation (OR 0.99, 95% CI 0.82-1.19, P=0.92, I²=0%), as well as mesenteric or limb ischemia (OR 0.73, 95% CI 0.22-2.43, P=0.61, I²=77%; OR 0.83, 95% CI 0.30-2.30, P=0.72, I²=76%, respectively). Males did experience significantly increased rates of acute renal failure and reoperation (OR 1.35, 95% CI 1.16-1.56, P=0.0001, I²=29%; OR 1.40, 95% CI 1.09-1.81, P=0.010, I²=42%).

Conclusions: Composite analysis indicates that early mortality does not differ between the sexes; however, late outcomes favor males. Differences in preoperative presentation and subsequent procedure selection between the sexes likely contribute to the disparity in late outcomes. Decision-making for surgical treatment of ATAAD should account for sex-specific risk factors.