Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective
Background: Male–female differences in clinical presentation, management, and outcomes of acute type A aortic dissection (AD-A) have been reported; however, robust data are scarce. This study examined those differences. Methods: Consecutive adults diagnosed with AD-A between 2007 and 2017 in 4 refer...
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Elsevier
2025-04-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273624004431 |
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| author | Frederike Meccanici, BSc Carlijn G.E. Thijssen, MD, PhD Arjen L. Gökalp, MD Marie H.E.J. van Wijngaarden, MD Mark F.A. Bierhuizen, MD Guy F. Custers, MD Jort Evers, BSc Jolien A. de Veld, MD Maximiliaan L. Notenboom, BSc Guillaume S.C. Geuzebroek, MD, PhD Joost F.J. ter Woorst, MD, PhD Jelena Sjatskig, MD Robin H. Heijmen, MD, PhD Mostafa M. Mokhles, MD, PhD Roland R.J. van Kimmenade, MD, PhD Jos A. Bekkers, MD, PhD Johanna J.M. Takkenberg, MD, PhD Jolien W. Roos-Hesselink, MD, PhD |
| author_facet | Frederike Meccanici, BSc Carlijn G.E. Thijssen, MD, PhD Arjen L. Gökalp, MD Marie H.E.J. van Wijngaarden, MD Mark F.A. Bierhuizen, MD Guy F. Custers, MD Jort Evers, BSc Jolien A. de Veld, MD Maximiliaan L. Notenboom, BSc Guillaume S.C. Geuzebroek, MD, PhD Joost F.J. ter Woorst, MD, PhD Jelena Sjatskig, MD Robin H. Heijmen, MD, PhD Mostafa M. Mokhles, MD, PhD Roland R.J. van Kimmenade, MD, PhD Jos A. Bekkers, MD, PhD Johanna J.M. Takkenberg, MD, PhD Jolien W. Roos-Hesselink, MD, PhD |
| author_sort | Frederike Meccanici, BSc |
| collection | DOAJ |
| description | Background: Male–female differences in clinical presentation, management, and outcomes of acute type A aortic dissection (AD-A) have been reported; however, robust data are scarce. This study examined those differences. Methods: Consecutive adults diagnosed with AD-A between 2007 and 2017 in 4 referral centers were included retrospectively. Baseline data, operative characteristics, and mortality and morbidity during follow-up were collected using patient files, questionnaires, and referral information. Results: The study included 889 patients (37.5% female). Females were significantly older at presentation (median, 67.0 [interquartile range [IQR], 59.0-75.0] years vs 61.0 [IQR, 53.0-69.0] years; P < .001) and more often had cardiovascular comorbidities. Severe hypotension, tamponade, and nausea were more frequently observed in females. Short-term mortality was 18.5% in females and 21.2% in males (P = .362). No significant differences in treatment between males and females were observed. After surgery, the median follow-up was 6.2 years (IQR, 3.5-9.2 years). Overall 10-year survival was 50.1% (95% confidence interval [CI], 43.6%-57.6%) in females and 62.8% (95% CI, 58.1%-67.9%) in males (P = .009), although this difference was not significant after multivariable correction. Compared to the matched general population, survival was lower than expected in females and comparable to expected in males. The long-term reintervention rate in surgically treated survivors was comparable between males and females (2.1%/patient-year). Male- and female-specific risk factors for long term mortality were identified. Conclusions: These findings highlight a distinct clinical profile at presentation with AD-A between males and females, while treatment approach and short-term mortality were comparable. The relatively poor long-term survival in females and male-/female-specific risk stratification warrant further investigation. |
| format | Article |
| id | doaj-art-25c8a6efa3894d12b0c37574a9c73b02 |
| institution | OA Journals |
| issn | 2666-2736 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj-art-25c8a6efa3894d12b0c37574a9c73b022025-08-20T02:25:02ZengElsevierJTCVS Open2666-27362025-04-0124475710.1016/j.xjon.2024.12.006Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspectiveFrederike Meccanici, BSc0Carlijn G.E. Thijssen, MD, PhD1Arjen L. Gökalp, MD2Marie H.E.J. van Wijngaarden, MD3Mark F.A. Bierhuizen, MD4Guy F. Custers, MD5Jort Evers, BSc6Jolien A. de Veld, MD7Maximiliaan L. Notenboom, BSc8Guillaume S.C. Geuzebroek, MD, PhD9Joost F.J. ter Woorst, MD, PhD10Jelena Sjatskig, MD11Robin H. Heijmen, MD, PhD12Mostafa M. Mokhles, MD, PhD13Roland R.J. van Kimmenade, MD, PhD14Jos A. Bekkers, MD, PhD15Johanna J.M. Takkenberg, MD, PhD16Jolien W. Roos-Hesselink, MD, PhD17Department of Congenital Cardiology, Erasmus MC, Rotterdam, The NetherlandsDepartment of Congenital Cardiology, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiothoracic Surgery, Utrecht University Medical Center, Utrecht, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Congenital Cardiology, Erasmus MC, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Cardiothoracic Surgery, Catharina Ziekenhuis, Eindhoven, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, St Antonius Ziekenhuis, Nieuwegein, The NetherlandsDepartment of Cardiology, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Congenital Cardiology, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiothoracic Surgery, Utrecht University Medical Center, Utrecht, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The NetherlandsDepartment of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The NetherlandsDepartment of Congenital Cardiology, Erasmus MC, Rotterdam, The Netherlands; Address for reprints: Jolien W. Roos-Hesselink, MD, PhD, Department of Congenital Cardiology, Erasmus MC, Rg-419, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.Background: Male–female differences in clinical presentation, management, and outcomes of acute type A aortic dissection (AD-A) have been reported; however, robust data are scarce. This study examined those differences. Methods: Consecutive adults diagnosed with AD-A between 2007 and 2017 in 4 referral centers were included retrospectively. Baseline data, operative characteristics, and mortality and morbidity during follow-up were collected using patient files, questionnaires, and referral information. Results: The study included 889 patients (37.5% female). Females were significantly older at presentation (median, 67.0 [interquartile range [IQR], 59.0-75.0] years vs 61.0 [IQR, 53.0-69.0] years; P < .001) and more often had cardiovascular comorbidities. Severe hypotension, tamponade, and nausea were more frequently observed in females. Short-term mortality was 18.5% in females and 21.2% in males (P = .362). No significant differences in treatment between males and females were observed. After surgery, the median follow-up was 6.2 years (IQR, 3.5-9.2 years). Overall 10-year survival was 50.1% (95% confidence interval [CI], 43.6%-57.6%) in females and 62.8% (95% CI, 58.1%-67.9%) in males (P = .009), although this difference was not significant after multivariable correction. Compared to the matched general population, survival was lower than expected in females and comparable to expected in males. The long-term reintervention rate in surgically treated survivors was comparable between males and females (2.1%/patient-year). Male- and female-specific risk factors for long term mortality were identified. Conclusions: These findings highlight a distinct clinical profile at presentation with AD-A between males and females, while treatment approach and short-term mortality were comparable. The relatively poor long-term survival in females and male-/female-specific risk stratification warrant further investigation.http://www.sciencedirect.com/science/article/pii/S2666273624004431Stanford type A aortic dissectionclinical presentationoutcomessurvivalsexgender |
| spellingShingle | Frederike Meccanici, BSc Carlijn G.E. Thijssen, MD, PhD Arjen L. Gökalp, MD Marie H.E.J. van Wijngaarden, MD Mark F.A. Bierhuizen, MD Guy F. Custers, MD Jort Evers, BSc Jolien A. de Veld, MD Maximiliaan L. Notenboom, BSc Guillaume S.C. Geuzebroek, MD, PhD Joost F.J. ter Woorst, MD, PhD Jelena Sjatskig, MD Robin H. Heijmen, MD, PhD Mostafa M. Mokhles, MD, PhD Roland R.J. van Kimmenade, MD, PhD Jos A. Bekkers, MD, PhD Johanna J.M. Takkenberg, MD, PhD Jolien W. Roos-Hesselink, MD, PhD Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective JTCVS Open Stanford type A aortic dissection clinical presentation outcomes survival sex gender |
| title | Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective |
| title_full | Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective |
| title_fullStr | Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective |
| title_full_unstemmed | Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective |
| title_short | Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective |
| title_sort | presentation management and clinical outcomes of acute type a dissection does sex matter central messageperspective |
| topic | Stanford type A aortic dissection clinical presentation outcomes survival sex gender |
| url | http://www.sciencedirect.com/science/article/pii/S2666273624004431 |
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