Gender differences in the outcomes after ascending aortic and aortic arch surgery

Objective. To assess the gender differences in patients with ascending aorta and aortic arch lesions in early postoperative period. Material and methods. The prospective study included 806 patients with ascending aorta and aortic arch lesions, who were divided into 2 groups: group 1 — 204 women, group 2 — 602 men. All patients underwent ascending aorta and aortic arch replacement at the Petrovsky National Research Center of Surgery between 2017 and 2021 and the Polyakov Regional Clinical Cardiology Dispensary between 2013 and 2021. Preoperative data, intraoperative variables, early postoperative period and in-hospital mortality were assessed. Predictors of in-hospital mortality were identified. Results. Thirty-day mortality was significantly higher in women (7.4% and 3.1% in women and men, respectively, p=0.02). Duration of mechanical ventilation was longer in the same group (15±14 and 12±10 hours, respectively, p=0.02). Mean blood loss within the 1st day after surgery was higher in women (887±852 and 780±442 ml, respectively, p=0.03). Incidence of neurological complications was also higher in women (3.9% vs 1.2%, p=0.01). Independent predictors of 30-day mortality in men included smoking, serum creatinine >110 mmol/L, heart failure NYHA class II-IV, urgency of surgery and aortic cross-clamping time >120 min; in women — emergency surgery and serum creatinine >100 mmol/l. Conclusion. Surgical treatment of females with ascending aorta and aortic arch lesions is associated with more severe early postoperative period and higher 30-day postoperative mortality.