{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T18:42:29Z","timestamp":1780598549172,"version":"3.54.1"},"reference-count":24,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T00:00:00Z","timestamp":1709769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Acute type A aortic dissection (AAD) is a life-threatening disease. No differences between men and women have been made in the treatment of AAD so far and knowledge about sex differences regarding long-term outcomes is limited. Materials and Methods: Between 01\/2004 and 12\/2021, 874 patients were operated on for AAD, including 313 (35.8%) women and 561 (64.2%) men. Clinical and surgical records, including long-term follow-up information, were obtained and analyzed retrospectively. To account for differences in the outcome determined by different preoperative life expectancies, a subgroup analysis for a set of patients matched according to their remaining life expectancy was performed. Results: At the time of AAD, women were older than men (69.1 \u00b1 13.0 vs. 61.8 \u00b1 13.3 years, p &lt; 0.001) and had a shorter remaining statistical life expectancy (18.6 \u00b1 10.8 vs. 21.4 \u00b1 10.4 years, p &lt; 0.001). Significantly more DeBakey type II AAD was found in women (37.1% vs. 25.7%, p &lt; 0.001). Comorbidities and preoperative status at the time of presentation were similar in women and men. More hemiarch procedures (63.3% vs. 52.0%, p &lt; 0.001) and less arch replacements (8.6% vs. 16.6%, p &lt; 0.001) were performed in women, resulting in shorter cross-clamp times for women (92 \u00b1 39 vs. 102 \u00b1 49 min, p &lt; 0.001). The in-hospital mortality was similar in women and men (11.5% vs. 12.7%, p = 0.618). Long-term survival was significantly shorter in women compared to men (9.8 [8.1\u201311.5] vs. 15.1 [11.9\u201318.4] years, p = 0.011). A matched subgroup analysis revealed that when comparing groups with a similar remaining life expectancy, the long-term survival showed no significant differences between women and men (9.8 [7.9\u201311.6] vs. 12.4 [10.1\u201314.7] years, p = 0.487). Conclusions: There are sex differences in AAD, with DeBakey type II dissection being more frequent in women. The seemingly worse long-term outcome can mostly be attributed to the shorter remaining statistical life expectancy at the time of presentation.<\/jats:p>","DOI":"10.3390\/medicina60030443","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T11:33:06Z","timestamp":1709811186000},"page":"443","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Sex Differences in Short- and Long-Term Survival after Acute Type A Aortic Dissection"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0553-1826","authenticated-orcid":false,"given":"Philipp","family":"Pfeiffer","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Brendel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany"},{"name":"Department of Thoracic Surgery, Thoraxklinik Heidelberg, Heidelberg University Hospital, 69126 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3354-2896","authenticated-orcid":false,"given":"Romina Maria","family":"R\u00f6sch","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany"},{"name":"Department of Thoracic Surgery, Thoraxklinik Heidelberg, Heidelberg University Hospital, 69126 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Probst","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Ghazy","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0259-0844","authenticated-orcid":false,"given":"Edoardo","family":"Zancanaro","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6070-9490","authenticated-orcid":false,"given":"Hazem","family":"El Beyrouti","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Treede","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel-Sebastian","family":"Dohle","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/00005792-195809000-00003","article-title":"Dissecting aneurysm of the aorta: A review of 505 cases","volume":"37","author":"Hirst","year":"1958","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1378\/chest.117.5.1271","article-title":"Epidemiology and clinicopathology of aortic dissection","volume":"117","author":"Meszaros","year":"2000","journal-title":"Chest"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"176","DOI":"10.4065\/79.2.176","article-title":"Acute aortic dissection: Population-based incidence compared with degenerative aortic aneurysm rupture","volume":"79","author":"Clouse","year":"2004","journal-title":"Mayo Clin. Proc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/S0140-6736(14)61005-9","article-title":"Management of acute aortic dissection","volume":"385","author":"Nienaber","year":"2015","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1161\/CIRCULATIONAHA.118.035805","article-title":"Sex-Related Differences in Patients Undergoing Thoracic Aortic Surgery","volume":"139","author":"Chung","year":"2019","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e3100","DOI":"10.1097\/MD.0000000000003100","article-title":"Sex-Related Differences between Patients with Symptomatic Acute Aortic Dissection","volume":"95","author":"Maitusong","year":"2016","journal-title":"Medicine"},{"key":"ref_7","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":"Nienaber","year":"2004","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.amjcard.2011.08.012","article-title":"Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD])","volume":"109","author":"Suzuki","year":"2012","journal-title":"Am. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.jtcvs.2015.06.031","article-title":"Gender differences in patients undergoing surgery for acute type A aortic dissection","volume":"150","author":"Fukui","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","first-page":"702","article-title":"Impact of gender on long-term outcomes after surgical repair for acute Stanford A aortic dissection: A propensity score matched analysis","volume":"24","author":"Sabashnikov","year":"2017","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.amjcard.2013.03.034","article-title":"Comparison by meta-analysis of mortality after isolated coronary artery bypass grafting in women versus men","volume":"112","author":"Alam","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1093\/ejcts\/ezaa156","article-title":"Prediction of mortality rate in acute type A dissection: The German Registry for Acute Type A Aortic Dissection score","volume":"58","author":"Czerny","year":"2020","journal-title":"Eur. J. Cardio-Thorac. Surg. Off. J. Eur. Assoc. Cardio-Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.jtcvs.2018.03.144","article-title":"Low rate of reoperations after acute type A aortic dissection repair from the Nordic Consortium Registry","volume":"156","author":"Pan","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1161\/CIRCULATIONAHA.117.031264","article-title":"Insights from the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research","volume":"137","author":"Evangelista","year":"2018","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"368","DOI":"10.21037\/acs.2016.06.02","article-title":"Current surgical results of acute type A aortic dissection in Japan","volume":"5","author":"Okita","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"093","DOI":"10.1055\/s-0034-1396341","article-title":"Effects of Gender on Outcomes and Survival Following Repair of Acute Type A Aortic Dissection","volume":"24","author":"Conway","year":"2014","journal-title":"Int. J. Angiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"007","DOI":"10.1055\/s-0039-1687900","article-title":"Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)","volume":"07","author":"Chemtob","year":"2019","journal-title":"AORTA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1038\/ncpcardio1417","article-title":"Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: The Penn classification","volume":"6","author":"Augoustides","year":"2009","journal-title":"Nat. Clin. Pr. Cardiovasc. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1016\/j.athoracsur.2011.05.011","article-title":"Mortality in acute type A aortic dissection: Validation of the Penn classification","volume":"92","author":"Olsson","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.amjcard.2013.11.017","article-title":"Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection","volume":"113","author":"Kimura","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/S0140-6736(07)61380-4","article-title":"Global burden of COPD: Risk factors, prevalence, and future trends","volume":"370","author":"Mannino","year":"2007","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.jtcvs.2019.11.039","article-title":"Gender-related differences in patients with acute aortic dissection type A","volume":"162","author":"Rylski","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.jtcvs.2009.11.014","article-title":"Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD)","volume":"140","author":"Trimarchi","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"11S","DOI":"10.1016\/j.jvs.2012.08.126","article-title":"Diseases of the thoracic aorta in women","volume":"57","author":"Huynh","year":"2013","journal-title":"J. Vasc. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/3\/443\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:10:35Z","timestamp":1760105435000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/3\/443"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,7]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["medicina60030443"],"URL":"https:\/\/doi.org\/10.3390\/medicina60030443","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,7]]}}}