Sex differences in patient outcomes following surgical intervention for acute type A aortic dissection in Armenia

Abstract

Background: Acute aortic dissection is a life-threatening pathology with a very high risk of mortality if untreated. Surgical treatment of acute A type aortic dissection (AAAD) decreases mortality rates; however, in-hospital mortality risk still remains high. Sex differences in postsurgical outcomes of AAAD are controversial in literature. Objective: The study was conducted in two tertiary care hospitals in Armenia, at the Nork Marash Medical center (NMMC) and the Astghik Medical Center (AMC). The primary objective of the study was to evaluate differences in in-hospital mortality of AAAD between sexes. Secondary objectives included the evaluation of differences in inhospital morbidity (complications), differences in patient profiles and disease manifestation of AAAD between sexes as well as investigation of the predictors of inhospital mortality, changes in patient outcomes over time and the validity of the LeipzigHalifax (LH) score to predict mortality in Armenian AAAD population. Methods: We conducted a retrospective cohort study with inclusion of all patients who were admitted to the NMMC and AMC and underwent surgery for AAAD from January 1, 2008 to April 1, 2018. Information from the medical records were extracted and analyzed. To estimate the independent effect of sex on in-hospital mortality and to evaluate the independent predictors of in-hospital mortality we conducted multivariable logistic regression analyses.Results: Overall, 211 patients were included in the study. The majority were males (76.3%, n = 161). Females were significantly older than males (59.2 ± 10.3 vs. 55.8 ± 9.1, p = 0.027). After adjustment for age, LH score and cardiopulmonary bypass (CPB) time sex was not an independent predictor of in-hospital mortality for patients with AAAD (OR = 0.526, 95 % CI: 0.22 to 1.43). LH score and CPB time ≥ 240 minutes were the predictors of in-hospital mortality. Based on adjusted analysis, no difference in inhospital mortality was observed between 2008-2012 and 2013-2018 time periods. Model discrimination for the LH score assessed by area under the receiver operating curve was fair (AUC ROC = 0.634).Conclusions: We did not find difference in in-hospital mortality of surgically treated AAAD between males and females in Armenia. Longer CPB time and severity at presentation measured by the LH score were the independent predictors of in-hospital mortality after AAAD surgery. The predictive power of LH score was fair for the Armenian population. It is important to evaluate the long-term outcomes of AAAD in this cohort.