Gender-related outcomes after open repair of descending thoracic and thoracoabdominal aortic aneurysms.

Autor:	Girardi LN; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY. Electronic address: lngirard@med.cornell.edu., Leonard JR; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY., Lau C; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY., Ohmes LB; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY., Gambardella I; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY., Iannacone EM; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY., Munjal M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY., Schwann AN; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY., Gaudino MFL; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2019 Apr; Vol. 69 (4), pp. 1028-1035.e1. Date of Electronic Publication: 2018 Oct 03.
DOI:	10.1016/j.jvs.2018.06.213
Abstrakt:	Objective: Female sex has been associated with greater morbidity and mortality for a variety of major cardiovascular procedures. We sought to determine the influence of female sex on early and late outcomes after open descending thoracic aortic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair. Methods: We searched our aortic surgery database to identify patients having open DTA or TAAA repair. Logistic regression and Cox regression analyses were used to assess the effect of sex on perioperative and long-term outcomes. Results: From 1997 until 2017, there were 783 patients who underwent DTA or TAAA repair. There were 462 male patients and 321 female patients. Female patients were significantly older (67.6 ± 13.9 years vs 62.6 ± 14.7 years; P < .001), had more chronic pulmonary disease (47.0% vs 35.7%; P = .001) and forced expiratory volume in 1 second <50% (28.3% vs 18.2%; P < .001), and were more likely to have degenerative aneurysms (61.7% vs 41.6%; P < .001). Operative mortality was not different between women and men (5.6% vs 6.2%; P = .536). However, women were more likely to require a tracheostomy after surgery (10.6% vs 5.0%; P = .003) despite a reduced incidence of left recurrent nerve palsy (3.4% vs 7.8%; P = .012). Logistic regression found female sex to be an independent risk factor for a composite of major adverse events (odds ratio, 2.68; confidence interval, 1.41-5.11) and need for tracheostomy (odds ratio, 3.73; confidence interval, 1.53-9.10). Women also had significantly lower 5-year survival. Conclusions: Women undergoing open DTA or TAAA repair are not at greater risk for operative mortality than their male counterparts are. Reduced preoperative pulmonary function may contribute to an increased risk for respiratory failure in the perioperative period. (Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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