Sex-Specific Outcome after Ascending Aortic Surgery in Moderate Hypothermic Circulatory Arrest

• DOI: 10.1055/s-0039-1698409
• Publication Date: 2019-10-11T23:01:06Z
• Authors: Miriam Freundt; Christine Friedrich; Mohamed Ahmed Salem; Bernd Panholzer; Katharina Huenges; Thomas Puehler; Jochen Cremer; Assad Haneya
• Keywords: Male; Time Factors; Health Status Disparities; Middle Aged; Risk Assessment; Aortic Aneurysm; 3. Good health; Blood Vessel Prosthesis Implantation; 03 medical and health sciences; Postoperative Complications; Sex Factors; Treatment Outcome; 0302 clinical medicine; Hypothermia, Induced; Risk Factors; Heart Arrest, Induced; Humans; Female; Vascular Calcification; Aged; Retrospective Studies

Abstract Background Historically, female patients had worse outcome undergoing heart surgery. No recent data exist on gender-specific outcome after moderate hypothermic circulatory arrest (MHCA). The aim of this large retrospective analysis was to investigate gender disparity in patients undergoing elective surgery of ascending aorta in MHCA at 24°C. Methods We conducted a retrospective review of 905 (33.3% female) cases of elective heart surgery in MHCA for ascending aortic aneurysm (90.9%) or severely calcified aorta (12.5%) between 2001 and 2015. Furthermore, 299 female and 299 male patients matched by propensity score were compared. Patients with dissection of the aorta were excluded. Results Women were older (68.4 ± 9.9 vs. 65.8 ± 11.6 years; p = 0.002), had higher logistic EuroSCORE I (18.4 [11.7; 29.2] vs. 12.3% [7.4; 22.6]; p < 0.001), and significantly shorter cardiopulmonary bypass (CPB) time (132 [105; 175] vs. 150 [118; 192] minutes; p < 0.001), while mean MHCA time was longer (15 [13; 19] vs. 14 [12; 17] minutes; p = 0.003). Surgical procedures were less complex in women and they were treated more frequently by isolated supracoronary ascending aorta replacement (61 vs. 54%; p = 0.046). Postoperatively, men showed a higher incidence of neurologic complications (7.0 vs. 3.3%; p = 0.03). The 30-day mortality (women 4.9% vs. men 3.9%; p = 0.48) did not differ significantly, likewise after statistical matching (4.7 vs. 2.3%; p = 0.120). Age, CPB time, and blood transfusion, but not female gender, were risk factors for mortality in multivariable regression analysis. Conclusion This study supports the hypothesis that female gender is not associated with increased short-term mortality or perioperative adverse events in elective aortic surgery in MHCA.