Sex‐based differences in acute type A aortic dissection—Biology or bias?

Sex ‐ based outcomes following repair of acute type A aortic dissection (ATAAD) has been of considerable interest among researchers and the study by Yousef et al is another attempt to establish the impact of gender on outcomes. 1 The authors have examined a large institutional database over a 15 ‐ year period and concluded that while there are differences in presentation, mortality is essentially similar between males and females. The patient numbers were substantial ( n =601) and multivariable Cox proportional ‐ hazards regression model for mortality in the entire cohort confirmed that gender was not an independent risk factor. The authors also carried out a propensity matched comparison between males and females undergoing repair of ATAAD. Both the unmatched and propensity matched comparisons confirmed that ventilation time was prolonged in females, but there was no statistically significant difference in operative or long ‐ term mortality