Male-Female Differences in Long-term Mortality after Ascending Aortic Surgery

Objective: The aim of this study is to determine male-female differences in patient and procedural characteristics, survival, and risk factors for long-term mortality in patients undergoing ascending aortic surgery. Methods: All consecutive patients who underwent ascending aortic aneurysm surgery with or without aortic root and/or aortic valve surgery between 01/1991 - 12/2016 in the authors’ institution were retrospectively analyzed. Patient and procedural characteristics, hospital mortality, and 15-year survival were compared between male and female patients. Cox-regression analyses were conducted to explore male-female differences in risk factors for long-term mortality. Results: Of the 600 included patients, 35% were female. Female patients were older (67 versus 56 years, p<0.001), had a higher EuroSCORE (11.7 versus 8.0, p<0.001), and more often underwent concomitant arch surgery (77% versus 56%, p<0.001). Aortic diameter (mean 5.9 versus 5.5 cm and median 5.6 versus 5.5 cm, p=0.006) and Aortic Size Index (3.2 versus 2.7 cm/mm2, p<0.001) were larger in female patients. Hospital mortality was comparable (0.5% versus 1.8%, p=0.271). At 15 years survival was 45% and 77% in females and males, respectively. Multivariable Cox-regression did not identify female sex as an independent risk factor for long-term mortality (HR 0.78, 95%-CI 0.46-1.31, p=0.434). Multivariable analysis stratified for sex identified only age as an independent risk factor for long-term mortality in both sexes (females HR 1.08, 95%-CI 1.04-1.13, p<0.001; males HR 1.11, 95%-CI 1.08-1.15, p<0.001). Conclusions: Female patients seem to present with more advanced disease at surgery compared to male patients, indicating the necessity of further sex-specific research into the processes underlying these differences. (ZonMW projectnumber: 849200014)