P298. Sex Difference Analysis after Aortic Dissection from The Houston Aortic Collaborative Experience
McGovern Medical School at UTHealth
Houston, TX
United States - Contact Me
Avanced Aortic Surgery Fellow at Memorial Hermann Hospital, Houston.
I currently live in Houston, where I am completing a two- year Fellowship in advanced aortic surgery. I am greatly engaged in open surgery for aortic aneurysms and dissections, as well as in modern vascular surgery, with large interest in vascular innovations, latest technology in vascular and aortic endovascular surgery, and greatly interested in medical and academic education, as well as surgical simulation.
I previously joined La Fe University Hospital in 2014 as a junior physician in angiology and vascular surgery, within the department of vascular surgery.
Prior to La Fe, I was the first Spanish junior vascular surgeon to complete a senior clinical Fellowship in aortic surgery at St. Mary’s Hospital, Imperial College of London, during an 18- month period,
and one of the first Spanish surgeons to become an official fellow of the European board of vascular and endovascular surgery (FEBVS).
Prior to this experience, I completed my residency in vascular surgery at Gregorio Marañón University hospital in Madrid, during a five- year period.
During my tenure in Madrid, I helped the hospital with the medical and residents training program, and participated in several national and international simulation courses, workshops, and meetings.
I am a graduate of the University of Alcala in Madrid, where I majored my bachelor in medicine.
Description
Data on sex-related differences in presentation, management, and clinical outcome in acute aortic dissection (AAD) are scarce, especially for acute type A (AAAD) and acute type B (ABAD) subtypes.
The aim was to determine the effect of sex on AAD presentation, management and outcomes in a large cohort of patients from two major aortic surgery centers.
Methods
We retrospectively reviewed the two-institution clinical data of all consecutive patients treated for AAD from 2000 to 2023. Data were analyzed by univariate and multivariable methods for short- and long-term data. Cox multivariable analyses were restricted to 3 years' follow-up.
Results
Overall, 2,269 patients treated for AADs with 1,380 AAAD and 889 ABAD. Median age was 60 years (IQR:50-71); 779 (34%) were women. Women were older (63 vs 58 yrs; P<.001), had lower baseline renal function (39% vs 26%, p<.001) and more genetically triggered aortic disease (11% vs 7%, P=.008). Clinical presentation is shown in Table. Women had fewer renal (13% vs 18%; P=.004), bleeding (13% vs 19%; P=.001), and GI (24% vs 28%; P=.049) in-hospital complications. 30-day mortality was not different between groups (11% vs 13%; P=.134). There was no significant difference in mid or long-term survival by sex overall, but Kaplan Meir analysis suggest a possible difference in the type A group, notably in the first 3 years (Figure 1, p<.001). Among AAAD cases, risk factors for mid (3-years) and long-term mortality were examined to assess the independent effect of female sex. Absolute risk difference of midterm mortality attributable to COPD in stratified analysis was 15% in women (p<.01). Multivariable risk factors for midterm and long term mortality after AAAD were female (HR 1.4, p<.02), rupture (HR 2.0, p<.001), CAD (HR 1.7, p<.001), mesenteric MPS (HR 2.3, p<.001). After adjusting for these risk factors, midterm as well as long-term survival among women with AAAD was significantly lower compared to males (Figure 2, p<.017).
Conclusions
Women with AAD presented at an older age with poor baseline renal function and had higher prevalence of genetic disease and ABAD. 3-year adjusted survival for women with AAAD was worse than men; COPD may modify risk by sex. Independent risk factors for mid and long-term mortality after AAAD included rupture, mesenteric malperfusion, CAD, and female sex.
Authors
Lucas Ribe (1), Rana Afifi (2), Yuki Ikeno (1), Akiko Tanaka (3), Charles Miller (4), Harleen Sandhu (5), Gustavo Oderich (1), Anthony Estrera (3)
Institutions
(1) McGovern Medical School at UTHealth, Houston, TX, (2) Memorial Hermann, Houston, TX, (3) Memorial Hermann Heart and Vascular Institute, Houston, TX, (4) Memorial Hermann Texas Medical Center, Houston, TX, (5) N/A, HOUSTON, TX