Sex-Related Differences in Patients Undergoing Thoracic Aortic Surgery: Evidence From the Canadian Thoracic Aortic Collaborative

Researchers of the Canadian Thoracic Aortic Collaborative (CTAC) analyzed the operative outcomes in 1653 patients (30% women) undergoing thoracic aortic surgery with hypothermic circulatory arrest between 2002 and 2017 in 10 institutions. Outcomes of interest were in-hospital death, stroke, and a modified Society of Thoracic Surgeons-defined composite (STS-COMP) for mortality or major morbidity (stroke, renal failure, deep sternal wound infection, reoperation, prolonged ventilation).

Compared with men, women were older (66 versus 61 years; P < 0.001) and had more hypertension and renal failure, but they had less coronary disease, less previous cardiac surgery, and higher ejection fractions. Rates of aortic dissection were similar between two genders, as were rates of hemiarch, total arch, and thoracoabdominal aortic repair. However, women had less aortic root reconstruction, including aortic root replacement, Ross, or valve-sparing root operations (29% versus 45%; P < 0.001). Men had longer cross-clamp and cardiopulmonary bypass times than women, but they had similar durations of circulatory arrest, methods of cerebral perfusion, and nadir temperatures. Women had a higher rate of death (11% versus 7.4%; P = 0.02), stroke (8.8% versus 5.5%; P = 0.01), and STS-COMP (31% versus 27%; P = 0.04). On multivariable analyses, female sex was an independent predictor of mortality (odds ratio [OR], 1.81; P < 0.001), stroke (OR, 1.90; P < 0.001), and STS-COMP (OR, 1.40; P < 0.001).

Given the worse outcomes in women, the authors call for earlier surgery once diagnosis of thoracic aortic disease is made in women and further investigation to better delineate which measures may reduce sex-related outcome differences after complex aortic surgery.