{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T07:39:13Z","timestamp":1786865953793,"version":"build-2736575974"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Although sex-related differences in cardiovascular surgery outcomes have increasingly garnered attention in the past decades, knowledge about sex disparities in the pathophysiology of acute type A aortic dissections (ATAADs) remains sparse. In this study, we evaluate the histopathologic and atherosclerotic lesions in female and male ATAAD patients.<\/jats:p><jats:p>\n          Methods\u2003A total of 68 patients were studied: 51 ATAAD patients (mean age: 62.5\u2009\u00b1\u200910.8 years; 49% women) and 17 control patients (mean age: 63\u2009\u00b1\u20095.5 years; 53% women). Cardiovascular risk factors were assessed clinically. Intimal and medial histopathological features were systematically evaluated in all.<\/jats:p><jats:p>\n          Results\u2003Compared to the control group, all ATAAD patients showed significantly more elastic fiber pathology, mucoid extracellular matrix accumulation, smooth muscle cell nuclei loss, and overall medial degeneration (p\u2009&lt;\u20090.0001). The tunica intima was significantly thinner in the ATAAD patients than in the control group (p\u2009&lt;\u20090.023), with the latter exhibiting significantly more progressive atherosclerotic lesions than the former. No difference in medial vessel wall pathology was seen between female and male patients. As compared to male ATAAD patients, atherosclerotic lesions were more severe in female ATAAD patients, independent of age and the cardiovascular risk factor hypertension.<\/jats:p><jats:p>\n          Conclusion\u2003All ATAAD patients had a significantly thinner tunica intima and significantly diseased tunica media compared to the control patients. Our results suggest that the severity of medial aortic pathology is not sex specific in ATAAD patients. Intimal differences between females and males could, however, be considered a potential risk factor for the development of an aortic dissection.<\/jats:p>","DOI":"10.1055\/a-2239-1741","type":"journal-article","created":{"date-parts":[[2024,1,6]],"date-time":"2024-01-06T00:02:58Z","timestamp":1704499378000},"page":"057-065","source":"Crossref","is-referenced-by-count":2,"title":["Sex Differences in the Histopathology of Acute Type A Aortic Dissections"],"prefix":"10.1055","volume":"73","author":[{"given":"Nimrat","family":"Grewal","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onur Baris","family":"Dolmaci","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, Netherlands"},{"name":"Department of Cardiothoracic Surgery, Leiden Universitair Medisch Centrum, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert JM","family":"Klautz","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Poelmann","sequence":"additional","affiliation":[{"name":"Animal Sciences and Health, Leiden University, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,2,12]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"7434","DOI":"10.1038\/s41598-020-64299-4","article-title":"Incidence of acute type A aortic dissection in emergency departments","volume":"10","author":"M Wundram","year":"2020","journal-title":"Sci Rep"},{"key":"ref2","volume-title":"Comprehensive Vascular and Endovascular Surgery. 2nd ed","author":"J W Hallett","year":"2009"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/S0741-5214(95)70227-X","article-title":"Ruptured thoracic aortic aneurysms: a study of incidence and mortality rates","volume":"21","author":"G Johansson","year":"1995","journal-title":"J Vasc Surg"},{"issue":"24","key":"ref4","first-page":"e223","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"80","author":"E M Isselbacher","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"41","key":"ref5","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult","volume":"35","author":"R Erbel","year":"2014","journal-title":"Eur Heart J"},{"issue":"24","key":"ref6","doi-asserted-by":"crossref","first-page":"3014","DOI":"10.1161\/01.CIR.0000130644.78677.2C","article-title":"Gender-related differences in acute aortic dissection","volume":"109","author":"C A Nienaber","year":"2004","journal-title":"Circulation"},{"issue":"10","key":"ref7","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1161\/CIRCULATIONAHA.107.702720","article-title":"Aortic diameter >or = 5.5\u2009cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD)","volume":"116","author":"L A Pape","year":"2007","journal-title":"Circulation"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"107478","DOI":"10.1016\/j.carpath.2022.107478","article-title":"Structural abnormalities in the non-dilated ascending aortic wall of bicuspid aortic valve patients","volume":"62","author":"N Grewal","year":"2023","journal-title":"Cardiovasc Pathol"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.carpath.2016.03.002","article-title":"Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: II. 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