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. 2024 Mar 14;3(4):100909.
doi: 10.1016/j.jacadv.2024.100909. eCollection 2024 Apr.

Operative Mortality After Type A Aortic Dissection Surgery: Differences Based on Sex and Age

Hong Liu  1 , Hai-Yang Li  2   3 , Yi-Lin Li  2   3 , Ying Wu  4 , Jia-Xi Gu  1 , Yi-Fei Diao  1 , Yong-Feng Shao  1 , Li-Zhong Sun  2   3 , Si-Chong Qian  2   3 , Hong-Jia Zhang  2   3 ; 5A Investigators
Affiliations

Operative Mortality After Type A Aortic Dissection Surgery: Differences Based on Sex and Age

Hong Liu et al. JACC Adv. .

Abstract

Background: There is controversy regarding sex differences in short-term mortality in acute type A aortic dissection (ATAAD).

Objectives: This study aimed to investigate the impact of sex differences on 30-day operative mortality after ATAAD surgery and to determine if other covariates modify the association.

Methods: Consecutive patients (N = 5670) with surgically repaired ATAAD were identified from the multicenter China 5A study. The primary outcome was operative mortality. The age dependency was modeled using a cubic spline curve.

Results: There were 1,503 females (26.5%) and 4,167 males (73.5%). Females were older and had a lower percentage of comorbidities compared with males. Females had higher mortality compared to males (10.2% vs 8.2%, P = 0.019); however, there was no difference after propensity analyses (adjusted OR: 1.334 [95% CI: 0.918-1.938]). There was an interaction with sex and age (P interaction = 0.035): older age was associated with higher odds of operative mortality among females (OR: 1.045 [95% CI: 1.029-1.061]) compared with males (OR: 1.025 [95% CI: 1.016-1.035]). The risk of mortality for males and females appears to diverge at 55 years of age (P interaction = 0.019): females under 55 years of age had similar odds to males (OR: 0.852 [95% CI: 0.603-1.205]) but higher odds when over 55 years (OR: 1.420 [95% CI: 1.096-1.839]) compared to males.

Conclusions: Under the age of 55 years, females have similar odds of operative mortality compared with males; however, over the age of 55 years females have higher odds than males. Understanding differences in risk allows for individualized treatment strategies. (Additive Anti-inflammatory Action for Aortopathy & Arteriopathy; NCT04398992).

Keywords: age; operative mortality; propensity score; sex; type A aortic dissection.

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Conflict of interest statement

This work was supported in part by the Scientific Research Common Program of 10.13039/501100002888Beijing Municipal Commission of Education (KM202110025014), 10.13039/501100009592Beijing Municipal Science and Technology Commission (Z211100002921010), and Jiangsu Province Capability Improvement Project through Science, Technology, and Education (ZDXK202230). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Spline Curve of Age With Risk Probability of Operative Mortality
Figure 2
Figure 2
Alluvial Plot of Distribution of Age Across Sex and Outcome
Figure 3
Figure 3
Number Needed to Harm: Sex and Age Differences With Operative Mortality
Figure 4
Figure 4
3-Way Interaction Analysis of Sex, Age, and Operative Mortality by Procedural Factors The figure represents the OR with 95% confidence interval for each subgroup. FET = frozen elephant trunk; TAR = total arch replacement.
Central Illustration
Central Illustration
Age and Sex Differences in Operative Mortality After Type A Aortic Dissection Surgery Under the age of 55 years, females have similar risk of operative mortality compared with males, however, over the age of 55 years females have higher risk than males. Understanding differences in risk allows for individualized treatment strategies.
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