Female patients with acute aortic dissection type A (AADA): A gender-selective evaluation of the intensity of the surgical treatment.

Abstract

Objective: Acute aortic dissection type A (AADA) is a condition that affects both genders and requires urgent surgical intervention as non-operative treatment is often associated with a poor prognosis. Studies have proven that less aggressive surgical treatments influence the outcome for female patients in the fields of several diseases. The purpose of this study was to report and analyze our results in the selective cohort of female patients with AADA to detect differences in the treatment of this group of patients.

Methods: Between January 2000 and July 2018, 141 adult female patients with acute aortic dissection (AAD) underwent repair of the aorta in our department. A total of 75 patients received a proximal arch. replacement (group A), and 66 patients received a subtotal (replacement of the brachiocephalic trunk) and/or total arch. replacement with elephant trunk or frozen elephant trunk (group B).

Results: The median age in group A was 70.7 years (range 60.7-74.7 years) and in group B 66.3 years (range 55.6-71.3 years). Operation times were significantly longer in group B (total operation time: A = 286.9 min (range 225.0-341.0 min), B = 341 min (range 266.0-392 min), p = .003; cardiopulmonary bypass time: A = 189.0 min (range 139.0-138 min), B = 238 min (range 176.8-300.5 min), p < .001; circulatory arrest time: A = 27.0 min (range 21.0-37.0 min), B = 42.0 min (range 32.0-56.3 min), p < .001). There were no significant differences between the groups regarding 30-day mortality (A = 24% (n = 18), B = 19.7% (n = 13), p = .538) and rate of reoperation (A = 13.3% (n = 10), B = 15.2% (n = 10), p = .757) or the preoperative characteristics.

Conclusion: Our study showed no significant difference in mortality rate depending on the type of operation. Based on these results, a proximal arch. replacement should be considered as the first line of operation technique if the individual situation allows. For inexperienced clinics and surgeons in particular, we recommend limited aortic repair in patients with AADA. Finally, location of the intimal tear remains the essential factor for the evaluation of the surgical treat.