The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery

Background: Older age and female sex are thought to be risk factors for adverse outcomes after repair of acute type A aortic dissection (AAAD). The aim of this study is to analyze age- and sex-related outcomes in patients undergoing AAAD repair.

Methods: Retrospective analysis of patients undergoing emergency AAAD repair. Patients were divided in Group A, patients aged ≥75 years and Group B <75. Intraoperative and postoperative data were compared between groups before and after propensity score matching. Sex differences were analyzed by age group.

Results: Between January 2006 and December 2018, 638 patients underwent emergency AAAD repair. Group A included 143 patients (22.4%), Group B 495 (77.6%). More patients in Group A presented with circulatory collapse (Penn C 26.6% vs. 9.7%, P=0.001) while Group B presented with circulatory collapse-branch malperfusion (Penn BC 29.3% vs. 15.4% P=0.001). After propensity score matching, Group B patients received more complex aortic root (33.6% vs. 23.2%, P=0.019) and concomitant bypass surgery (12.3% vs. 6.3%, P=0.042). There was no significant difference in in-hospital mortality between age groups (18% vs. 12% P=0.12). In Group B, in-hospital mortality was significantly higher in females (22.2% vs. 8.2%, P=0.028). Differences in mortality disappeared after the age of 75 (18.3% vs. 19.4% P=0.87).

Conclusions: Morbidity and mortality are comparable between patients under and over 75 years after AAAD repair. Female patients <75 had higher in-hospital mortality than their male counterparts.