P300. Sex Differences in Maximal Aortic Dimension at Acute Type A Dissection: Time for Sex-Specific Guidelines?
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Michigan Medicine
Ann Arbor, MI
United States - Contact Me
Dr. Catherine Wagner is a PGY-5 integrated cardiothoracic surgery resident at the University of Michigan. She is interested in cardiac surgery quality, sex outcomes disparities, and childbearing during training. Dr. Wagner is interested in pursuing a career in academic cardiac surgery.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Sex-specific intervention threshold guidelines exist for abdominal aortic aneurysms, but not for ascending thoracic aortic aneurysms. Maximum aortic diameter at time of acute type A dissection (ATAAD) was assessed to evaluate if absolute size threshold guidelines for ascending aneurysm disadvantage females.
Methods: All adult ATAAD surgical repairs at a single center from 7/2011-3/2023 were included. Patients excluded had previous cardiac surgery, known connective tissue disorder, poor quality CT or onset of symptoms >24 hours before index CT. Maximum ascending thoracic aortic aneurysm diameter was measured at the index CT using dedicated 3D analysis software in a double-oblique plane, orthogonal to the aortic centerline. Using Rylski criteria pre-dissection aortic diameter was estimated by reducing the maximal post-dissection diameter by 31%. A standard measurement protocol was used by 4 trained physicians with strong inter-rater agreement on a 30-case test-set (intra-class coefficient 0.76). Patient characteristics, median pre-dissection aortic diameter and cumulative distribution curves of pre-dissection aortic diameter were compared by sex. Multivariable linear regression was used to identify independent associations with pre-dissection aortic diameter.
Results: 566 patients underwent ATAAD repair. 383 patients (67%) with suitable index CT studies were analyzed, of these 138 (36%) were female. Hypertension incidence (83%) was similar by sex, though females were older [65 (IQR 55-74) vs 58 (IQR 48-66), p<0.001] and higher frequency of family history of aortic aneurysm/dissection/sudden death (8% vs 3%, p=0.049). Females had smaller estimated pre-dissection aortic diameter [38mm (IQR 35-43) vs 40mm (IQR 37-45), p=0.027] compared to males. Based on the recommended guideline threshold for ascending thoracic aortic aneurysm repair of ≥50 mm at experienced centers, 96% of females and 88% of males had an estimated pre-dissection aortic diameter below threshold size prior to onset of ATAAD (Figure). Adjusting for age and family history, female sex was an independent predictor of smaller pre-dissection aortic diameter at the time of dissection (β= -2.22; 95%CI -4.05 to -0.62, p=0.008). However, after controlling for body surface area in the regression, female sex was no longer predictive of smaller pre-dissection aortic diameter (β= -1.53; 95%CI -3.54 to 0.48, p=0.14).
Conclusions: Females have ATAAD at smaller aortic diameters compared to males, and females dissect prior to aneurysm repair size thresholds more than males. Sex-specific ascending thoracic aortic aneurysm criteria or criteria indexed to body surface area should be considered, and may decrease the incidence of ATAAD in females.
Authors
Catherine Wagner (1), Carlos Alberto Campello Jorge (2), Prabhvir Marway (2), Meganne Ferrel (2), Shinichi Fukuhara (2), Robert Hawkins (3), G. Michael Deeb (4), Himanshu Patel (5), Gorav Ailawadi (2), Bo Yang (2), Nicholas Burris (6), Barbara Hamilton (2)
Institutions
(1) Michigan Medicine, Ypsilanti, MI, (2) University of Michigan, Ann Arbor, MI, (3) University of Michigan, Department of Cardiac Surgery, Ann Arbor, MI, (4) Frankel Cardiovascular Center, Ann Arbor, MI, (5) University of Michigan Hospital, Ann Arbor, MI, (6) University of Michigan Heath System, Ann Arbor, MI
Methods: All adult ATAAD surgical repairs at a single center from 7/2011-3/2023 were included. Patients excluded had previous cardiac surgery, known connective tissue disorder, poor quality CT or onset of symptoms >24 hours before index CT. Maximum ascending thoracic aortic aneurysm diameter was measured at the index CT using dedicated 3D analysis software in a double-oblique plane, orthogonal to the aortic centerline. Using Rylski criteria pre-dissection aortic diameter was estimated by reducing the maximal post-dissection diameter by 31%. A standard measurement protocol was used by 4 trained physicians with strong inter-rater agreement on a 30-case test-set (intra-class coefficient 0.76). Patient characteristics, median pre-dissection aortic diameter and cumulative distribution curves of pre-dissection aortic diameter were compared by sex. Multivariable linear regression was used to identify independent associations with pre-dissection aortic diameter.
Results: 566 patients underwent ATAAD repair. 383 patients (67%) with suitable index CT studies were analyzed, of these 138 (36%) were female. Hypertension incidence (83%) was similar by sex, though females were older [65 (IQR 55-74) vs 58 (IQR 48-66), p<0.001] and higher frequency of family history of aortic aneurysm/dissection/sudden death (8% vs 3%, p=0.049). Females had smaller estimated pre-dissection aortic diameter [38mm (IQR 35-43) vs 40mm (IQR 37-45), p=0.027] compared to males. Based on the recommended guideline threshold for ascending thoracic aortic aneurysm repair of ≥50 mm at experienced centers, 96% of females and 88% of males had an estimated pre-dissection aortic diameter below threshold size prior to onset of ATAAD (Figure). Adjusting for age and family history, female sex was an independent predictor of smaller pre-dissection aortic diameter at the time of dissection (β= -2.22; 95%CI -4.05 to -0.62, p=0.008). However, after controlling for body surface area in the regression, female sex was no longer predictive of smaller pre-dissection aortic diameter (β= -1.53; 95%CI -3.54 to 0.48, p=0.14).
Conclusions: Females have ATAAD at smaller aortic diameters compared to males, and females dissect prior to aneurysm repair size thresholds more than males. Sex-specific ascending thoracic aortic aneurysm criteria or criteria indexed to body surface area should be considered, and may decrease the incidence of ATAAD in females.
Authors
Catherine Wagner (1), Carlos Alberto Campello Jorge (2), Prabhvir Marway (2), Meganne Ferrel (2), Shinichi Fukuhara (2), Robert Hawkins (3), G. Michael Deeb (4), Himanshu Patel (5), Gorav Ailawadi (2), Bo Yang (2), Nicholas Burris (6), Barbara Hamilton (2)
Institutions
(1) Michigan Medicine, Ypsilanti, MI, (2) University of Michigan, Ann Arbor, MI, (3) University of Michigan, Department of Cardiac Surgery, Ann Arbor, MI, (4) Frankel Cardiovascular Center, Ann Arbor, MI, (5) University of Michigan Hospital, Ann Arbor, MI, (6) University of Michigan Heath System, Ann Arbor, MI
Presentation Duration
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