Women Dissect at Smaller Aortic Diameters than Men

Background: We analyzed the dissection images of patients suffering from acute aortic dissection type A (AADA) to evaluate sex differences.

Methods: Images and outcomes were evaluated for 395 patients who underwent surgery for AADA between February 2003 and August 2023. Parameters that were measured included aortic diameters (root, ascending, arch, and descending aorta) and aortic lengths. Aortic height and aortic size index were calculated.

Results: Mean age at time point of AADA was 61 years. Thirty-two percent of patients were female. All patients who were included in this study underwent emergent surgery. 30-day mortality in our cohort was 17.5%. Four percent of patients had known genetic aortopathy and were listed separately in the imaging section. Twenty-one percent of patients had an anomaly of the supraaortic vessels (e.g., bovine arch, isolated left vertebral artery; women 27% versus men 18%; p = 0.02) and 5% had a bicuspid aortic valve (women 3% versus men 5%; p = 0.41). Mean ascending diameter at time point of AADA was 4.7 cm (women 4.5 cm versus men 4.8 cm; p = 0.045), mean root diameter 4.1 cm (women 3.7 cm versus men 4.3 cm, p ≤ 0.001), and 3.1 and 2.9 cm for the aortic arch and descending aorta. Average aortic length was 10 cm in the whole cohort (women 9.2 versus men 10.3; p = 0.02). Only 47% of patients had an aortic segment larger than 5 cm at time point of aortic dissection. Diameters indexed for patient height (aortic height index, AHI) were comparable between women (2.76) and men (2.67) (p = 0.24). Patients with congenital aortopathies had significantly larger aortic root diameters than patients without (4.9 cm versus 4.1 cm; p = 0.04). Twenty-four patients had CT imaging within one year prior to AADA, 5 of those patients had a known genetic aortopathy. Speaking of non-genetic patients, only 1 patient would have met the current I B threshold for surgery and in one more patient AADA could have been prevented by applying the current IIaB recommendations.

Conclusion: Only half of patients had an aortic segment larger than 5 cm in their dissected aortas and would have eventually met the current threshold for prophylactic surgery. Women showed smaller aortic diameters at time point of dissection and less aortic elongation. When indexed for patient height (not BSA), sex differences disappear.

Publication History

Article published online:
11 February 2025