Sex impacts outcome in minimally invasive surgery of the ascending aorta: a propensity score matched analysis.

BACKGROUND

Minimally invasive approaches have gained immense importance in surgery of the aortic valve, aortic root, and ascending aorta over the last decades. Despite this, data concerning impact factors of the postoperative outcome and especially investigations regarding sex-specific outcome parameters for minimally invasive aortic surgery are still lacking to date.

METHODS

We present a single-center analysis of 387 patients undergoing supracoronary ascending aorta replacement, Wheat procedure, David procedure, or Bentall procedure through a minimally invasive access. A multivariate linear model was developed to identify predicting factors for a prolonged intensive care unit stay. Subsequently, the impact of the patients sex on perioperative complications and outcome as well as short- and long-term survival was investigated using a propensity score matched analysis of each 118 women and men undergoing minimally invasive ascending aortic procedures.

RESULTS

Female sex, patients age at operation, and operation times were identified as independent patient-specific predictors for ICU length of stay after minimally invasive ascending aortic surgery. The perioperative stroke-rate was significantly higher in women compared to men (7.6% vs. 1.7%, p = 0.031). Erythrocyte concentrate transfusion requirement was significantly higher in females (4 (IQR 2-5) vs. 2 (QR 0-4), p < 0.001). No significant differences were found between male and female patients with respect to short- and long-term survival.

CONCLUSIONS

Sex impacts outcome after minimally invasive ascending aortic surgery. In particular, female patients had worse short-term outcome compared to men with respect to perioperative stroke, ICU length-of-stay, and transfusion requirements.