Sex differences in malperfusion and mid-term outcomes for acute type a aortic dissection

Background In-hospital mortality among patients with acute Type A aortic dissection remains as high as 22%, with malperfusion considered a major contributing factor. However, sex differences in malperfusion patterns and surgical outcomes have not been systematically investigated. Purpose This study aimed to investigate sex differences in the prevalence of malperfusion and mid-term surgical outcomes in patients undergoing surgery for acute Type A aortic dissection. Methods A total of 485 patients who underwent surgery for acute Type A aortic dissection between January 2015 and December 2017 were enrolled and divided into male (N=361) and female (N=124) groups. Baseline characteristics, prevalence of malperfusion, and 30-day and mid-term outcomes were compared between groups, with death as the primary endpoint. Results Male patients significantly outnumbered females. Compared with males, female patients were older (52.0 vs 47.0 years, P<0.001). Regarding malperfusion, female patients exhibited significantly lower rates of renal malperfusion (4.8% vs 19.1%, P<0.001) and gastrointestinal malperfusion (1.7% vs 5.6%, P=0.041), while no significant sex differences were observed in cerebral or cardiac malperfusion. Thirty-day survival did not differ significantly between sexes (Log-rank P=0.730). At a median follow-up of 6.2 years, mid-term survival also showed no significant difference (Log-rank P=0.372). Conclusion Significant sex differences exist in patients with acute Type A aortic dissection, with males predominating. Although female patients experience less frequent renal and gastrointestinal malperfusion, they are older and achieve postoperative survival rates comparable to those of males. These findings further underscore the clinically relevant sex disparities that must be considered in the management of aortic dissection and in the design of future clinical trials.