Background/Objectives: Ascending thoracic aortic aneurysms (aTAAs) pose a high risk of dissection and rupture. Though more prevalent in males, females may experience worse outcomes. Growth rate is considered a part of risk assessment, yet data in non-syndromic females without valve abnormalities remain limited. This study aims to assess whether aTAA growth differs between non-syndromic females and males with normal aortic valve morphology. Methods: The systematic review followed the PRISMA 2020 guideline. The final search was completed in April 2025, with guidance from a certified librarian. Included studies were RCTs or observational studies of non-syndromic adults with aTAA reporting sex-specific data and included ≥10 females. Prior dissection, valve replacement, or surgery were excluded. In addition to the original search, 11 articles were identified as likely to contain sex-specific data, and the corresponding authors were contacted. The protocol is registered in PROSPERO (CRD420251025890). Meta-analysis was not performed due to high heterogeneity and limited study numbers. Results: Of 2629 identified studies, 73 studies were screened in full-text, and only three met the inclusion criteria. The most common exclusion reason was lack of appropriately sex-stratified data. Two authors out of the 11 contacted replied with additional datasets, resulting in a total of five studies being included. Of the five included studies, three found faster growth rates in females. Reported growth rates in females varied notably, ranging from −0.7–1.74 mm/year. Conclusions: Evidence on sex differences in aTAA growth among non-syndromic patients with normal aortic valves remains inconclusive. Three of the five studies reported faster growth in females. Standardization in future research is needed.
Gylling et al. (Thu,) studied this question.