ArticleJournal of cardiothoracic surgery2026
Sex differences in outcomes of a two-stage approach to aortic arch surgery: 8-year experience of a national aortovascular centre.
Article in Journal of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHybrid surgery for aortic arch pathology consisting of a combined frozen elephant trunk (FET) and endovascular (TEVAR) treatment, confers a good prognosis with excellent outcomes. It is known that females, who often have higher risk profiles and more advanced disease at presentation, confer a worse prognosis post cardiac surgery compared to their male counterparts. We compare our outcomes of male and female patients after a two-stage approach.
methodsDemographic, survival and outcome data were retrospectively analysed in patients undergoing two-staged FET and endovascular surgery between January 2018 and January 2025.
results32 patients with mean age 60.8 years, underwent a two-stage surgery (endovascular N = 18 (56.2%) vs. open thoracoabdominal approach N = 14 (43.8%) 2nd stage)). 16 males (50%), with comparable demographics. Indications for FET surgery: incidence of chronic type A dissections were similar but females had fewer chronic type B dissections (2 vs. 9; p = 0.02; 0.1[0.02–0.6]); and more aneurysms (13 vs. 8; p = 0.14; 4.3[0.9–17.8]. Overall mortality: No in-hospital or 90-day mortality. Overall survival (OS) at 5-years was 87.1% vs. 77.9% for males and females respectively (p = 0.76). Complications: Females had more returns to theatre (4 vs. 2; p = 0.65; 2.3 [0.4–13.4]). LOS 16.0 vs. 13.5 days for males vs. females respectively (p = 0.54). 2nd stage surgery: Median interval between operations: 240 (males) vs. 140 days (females). OS correlated positively with increasing intervals in both males (p = 0.79; r = 0.07) and females (0.29; r-0.28). Overall complications were comparable. Females had more spinal ischaemia (7 vs. 3; p = 0.25; 3.3 [0.7–14]; but fewer females required renal replacement therapy (2 vs. 4; p = 0.65; 0.4[0.07–2.3].
conclusionSurvival and complications are comparable in males and females, with good long-term results, therefore a two-stage approach should be offered to all patients along with aortovascular multidisciplinary team (MDT) surveillance. Larger studies are required to validate our results.
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