Sex-specific outcomes following repair of acute type A aortic dissection

Purpose: This study aimed to investigate sex-specific differences in short- and long-term outcomes following surgical repair of acute type A aortic dissection (ATAAD). We hypothesized that female patients present at higher baseline risk, contributing to different outcomes than male patients. Methods: We performed a retrospective analysis of 765 patients (482 males, 283 females) who underwent ATAAD surgery from June 1984 to December 2024. Data included demographics, clinical presentation, operative variables, and postoperative outcomes. The primary endpoint was in-hospital mortality, and secondary endpoints included in-hospital morbidity measures and long-term mortality. Logistic regression model was utilized predictors of in-hospital mortality, and Cox proportional hazards regression was used for long-term survival. Results: Females were older, had higher rates of cerebrovascular events, and exhibited more iatrogenic dissections than males. In-hospital mortality was comparable (females 13.1%, males 16.4%; p = 0.258). In unadjusted cox regression model, female sex was associated with higher long-term mortality (Hazard Ratio (HR) = 1.319; p = 0.008), but this effect was not significant after risk adjustment (HR = 1.140; p = 0.241). Independent predictors of in-hospital mortality included malperfusion, older age at presentation and longer cardiopulmonary bypass times. Conclusion: Although female patients exhibited worse unadjusted long-term survival, these differences were largely attributed to preoperative risk factors rather than sex alone. The findings underscore the importance of timely diagnosis and individualized management for older female patients. Improving awareness and early intervention may reduce disparities and optimize outcomes in ATAAD repair.