Sex Differences in Outcomes After Type A Acute Aortic Dissection: An Analysis of the UK National Adult Cardiac Surgery Audit Registry

(1) Background: Type A acute aortic dissection (TAAAD) predominantly affects men, yet conflicting evidence persists regarding sex- and socioeconomic-related differences in outcomes. We evaluated these differences using a large national UK registry. (2) Methods: Patients undergoing TAAAD repair between 1996 and 2019 were identified from the National Adult Cardiac Surgery Audit (NACSA) and stratified by sex and socioeconomic status. In-hospital outcomes were compared and inverse probability weighting was applied to adjust for imbalances between groups and estimate the average treatment effect (ATE) of female versus male. (3) Results: A total of 2857 patients underwent TAAAD repair, including 1907 (67%) men and 950 (33%) women. Women were older and had lower BMI, while men more frequently presented with bicuspid aortic valve and aortic root aneurysm. The rates of aortic root replacement and total arch replacement were comparable between sexes, as was the median circulatory arrest time. No significant differences were observed in socioeconomic deprivation indices. In-hospital mortality (18.7% in men vs. 19% in women), cerebrovascular accident (12.5% vs. 12.5%), dialysis (14.5% vs. 14.6%), and length of stay (13 vs. 13 days) were comparable between sexes. After inverse probability weighting, female sex was not independently associated with in-hospital mortality or post-operative complications. (4) Conclusions: In this large UK registry, female sex was not independently associated with worse in-hospital outcomes after TAAAD repair.