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Almendárez M, Formica F, Gutierrez Sáenz de Santamaría J, Avanzas P, Escalera A, Alvarez-Velasco R, Pascual I, Silva J, Díaz R, Alperi A, Hernández-Vaquero D. Sex-Related Differences in Life Expectancy Compared to General Population after Surgery for Ascending Aortic Aneurysm. J Clin Med 2024; 13:4554. [PMID: 39124820 PMCID: PMC11313614 DOI: 10.3390/jcm13154554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Understanding sex-based differences in cardiovascular outcomes is paramount to improving clinical outcomes. Surgery is an aggressive but effective therapy for ascending aortic aneurysm. We sought to determine if being a woman is a risk factor for long-term mortality after this surgery. We compared their life expectancy with a general population of the same age, sex, year, and region. Methods: We compared men and women undergoing AAA surgery at our institution from 2000 to 2019. After balancing the population with propensity score (PS) matching, we compared long-term mortality control with a Cox regression. We determined the RS using the Ederer II method and compared it to a healthy reference population of the same age, sex, and region. Results: From 2000 to 2019, 232 women and 506 men underwent ascending aortic aneurysm surgery. After a mean follow-up of 51.5 ± 34.5 months, sex was not an independent risk factor for long-term mortality in the multivariable analysis [HR: 0.68 (95% CI 0.43-1.07, p = 0.23)]. Matching by baseline characteristics, 196 pairs were analyzed with no differences regarding mortality in the Cox regression [HR: 1.11 (95% CI 0.65-1.9, p = 0.23)]. Men and women who survived the postoperative period presented a relative survival of 100.3% (95% CI 97.4-101%) and 100.3% (95% CI 98.9-101.1%), respectively, similar to the reference population without the disease. Conclusions: For patients undergoing AAA surgery, sex was not an independent predictor of mortality. Men and women who survived the postoperative period presented a similar life expectancy to that of the reference population (people free from the disease of the same age, sex, year, and region).
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Affiliation(s)
- Marcel Almendárez
- Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; (M.A.); (A.E.); (R.A.-V.); (I.P.); (J.S.); (R.D.); (A.A.); (D.H.-V.)
- Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
| | - Francesco Formica
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
| | | | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; (M.A.); (A.E.); (R.A.-V.); (I.P.); (J.S.); (R.D.); (A.A.); (D.H.-V.)
- Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain;
- CIBER Cardiovascular, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alain Escalera
- Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; (M.A.); (A.E.); (R.A.-V.); (I.P.); (J.S.); (R.D.); (A.A.); (D.H.-V.)
| | - Rut Alvarez-Velasco
- Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; (M.A.); (A.E.); (R.A.-V.); (I.P.); (J.S.); (R.D.); (A.A.); (D.H.-V.)
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; (M.A.); (A.E.); (R.A.-V.); (I.P.); (J.S.); (R.D.); (A.A.); (D.H.-V.)
- Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain;
| | - Jacobo Silva
- Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; (M.A.); (A.E.); (R.A.-V.); (I.P.); (J.S.); (R.D.); (A.A.); (D.H.-V.)
| | - Rocío Díaz
- Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; (M.A.); (A.E.); (R.A.-V.); (I.P.); (J.S.); (R.D.); (A.A.); (D.H.-V.)
- Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
| | - Alberto Alperi
- Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; (M.A.); (A.E.); (R.A.-V.); (I.P.); (J.S.); (R.D.); (A.A.); (D.H.-V.)
- Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain; (M.A.); (A.E.); (R.A.-V.); (I.P.); (J.S.); (R.D.); (A.A.); (D.H.-V.)
- Research Institute of the Principado de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain
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Al-Tawil M, Friedrich C, Broll A, Salem M, Schoettler J, de Silva N, Kolat P, Schoeneich F, Haneya A. Sex-based disparities in ascending aortic aneurysm surgery outcomes: a comprehensive analysis of 1148 consecutive patients with propensity-score matching. J Cardiothorac Surg 2024; 19:331. [PMID: 38877532 PMCID: PMC11177366 DOI: 10.1186/s13019-024-02646-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/14/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Women undergoing cardiac surgery have been historically recognized to carry higher periprocedural mortality risk. We aimed to investigate the influence of sex on clinical presentation, perioperative, and long-term outcomes in patients who undergo surgery for ascending aortic aneurysm. METHODS We conducted a retrospective review of 1148 consecutive patients (380 [33.1%] female) who underwent thoracic aortic surgery under moderate hypothermic circulatory arrest for ascending aortic aneurysms between 2001 and 2021. Baseline and operative characteristics, in-hospital mortality, and survival were compared between male and female patients before and after propensity-score-matched (PSM) analysis. RESULTS Women were significantly older (median age: 69 [IQR: 63-75] vs. 67 [IQR: 58-73]; P < 0.001), while men had a higher prevalence of aortic valve stenosis, bicuspid valve and coronary artery disease at the time of surgery (P < 0.05). After PSM, EuroSCORE II (4.36 [2.68; 6.87] vs. 3.22 [1.85; 5.31]; p < 0.001), and indexed aortic diameter were significantly higher in female patients (2.94 [2.68; 3.30] vs. 2.58 [2.38; 2.81] cm/m2, p < 0.001). In the matched cohort, men were more likely to experience postoperative delirium (18.1% vs. 11.5%; P = 0.002), and postoperative neurological deficits (6.7% vs. 3.0%, P = 0.044),. Female patients were more likely to receive postoperative packed red blood cells (p = 0.036) and fresh frozen plasma (p = 0.049). In-hospital and 30-day mortality was similar between both groups. Long-term survival was comparable between both groups with 88% vs. 88% at 5 years, 76% vs. 71% at 10 years, and 59% vs. 47% at 15 years. CONCLUSION Female patients required more transfusions, while males had a higher incidence of postoperative delirium and neurological deficits. Differences in preoperative age and timing of surgery between the sexes could be attributed to variations in comorbidity profiles and the greater prevalence of concomitant surgery indications in males.
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Affiliation(s)
- Mohammed Al-Tawil
- Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany.
| | - Christine Friedrich
- Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany
| | - Alexandra Broll
- Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany
| | - Mohamed Salem
- Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany
| | - Jan Schoettler
- Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany
| | - Nora de Silva
- Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany
| | - Philipp Kolat
- Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital of Schleswig- Holstein, Campus Kiel, Kiel, Germany
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3
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Dagher O, Appoo JJ, Herget E, Atoui R, Baeza C, Brinkman W, Bozinovski J, Chu MWA, Dagenais F, Demers P, Desai N, El-Hamamsy I, Estrera A, Grau JB, Hughes GC, Jassar A, Kachroo P, Lachapelle K, Ouzounian M, Patel HJ, Pozeg Z, Tseng E, Whitlock R, Guo MH, Boodhwani M. Impact of nondiameter aortic indices on surgical eligibility: Results from the Treatment in Thoracic Aortic Aneurysm: Surgery Versus Surveillance (TITAN: SvS) randomized controlled trial. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00308-8. [PMID: 38692478 DOI: 10.1016/j.jtcvs.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Traditional criterion for intervention on an asymptomatic ascending aortic aneurysm has been a maximal aortic diameter of 5.5 cm or more. The 2022 American College of Cardiology/American Heart Association aortic guidelines adopted cross-sectional aortic area/height ratio, aortic size index, and aortic height index as alternate parameters for surgical intervention. The objective of this study was to evaluate the impact of using these newer indices on patient eligibility for surgical intervention in a prospective, multicenter cohort with moderate-sized ascending aortic aneurysms between 5.0 and 5.4 cm. METHODS Patients enrolled from 2018 to 2023 in the randomization or registry arms of the multicenter trial, Treatment In Thoracic Aortic aNeurysm: Surgery versus Surveillance, were included in the study. Clinical data were captured prospectively in an online database. Imaging data were derived from a core computed laboratory. RESULTS Among the 329 included patients, 20% were female. Mean age was 65.0 ± 11.6 years, and mean maximal aortic diameter was 50.8 ± 3.9 mm. In the one-third of all patients (n = 109) who met any 1 of the 3 criteria (ie, aortic size index ≥3.08 cm/m2, aortic height index ≥3.21 cm/m, or cross-sectional aortic area/height ≥ 10 cm2/m), their mean maximal aortic diameter was 52.5 ± 0.52 mm. Alternate criteria were most commonly met in women compared with men: 20% versus 2% for aortic size index (P < .001), 39% versus 5% for aortic height index (P < .001), and 39% versus 21% for cross-sectional aortic area/height (P = .002), respectively. CONCLUSIONS One-third of patients in Treatment In Thoracic Aortic aNeurysm: Surgery versus Surveillance would meet criteria for surgical intervention based on novel parameters versus the classic definition of diameter 5.5 cm or more. Surgical thresholds for aortic size index, aortic height index, or cross-sectional aortic area/height ratio are more likely to be met in female patients compared with male patients.
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Affiliation(s)
- Olina Dagher
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Alberta, Canada; Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jehangir J Appoo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Alberta, Canada.
| | - Eric Herget
- Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Rony Atoui
- Division of Cardiothoracic Surgery, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Cristian Baeza
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - William Brinkman
- Division of Cardiothoracic Surgery, Baylor Scott & White Health, Dallas, Tex
| | - John Bozinovski
- Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Francois Dagenais
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Philippe Demers
- Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Nimesh Desai
- Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Ismail El-Hamamsy
- Division of Cardiothoracic Surgery, Mount Sinai Hospital, New York, NY
| | - Anthony Estrera
- Department of Cardiothoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Juan B Grau
- Division of Cardiothoracic Surgery, The Valley Hospital, Ridgewood, NJ
| | - G Chad Hughes
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC
| | - Arminder Jassar
- Division of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | - Kevin Lachapelle
- Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Himanshu J Patel
- Division of Cardiiothoracic Surgery, University of Michigan Hospital, Ann Arbor, Mich
| | - Zlatko Pozeg
- Division of Cardiac Surgery, New Brunswick Heart Centre, Saint John, New-Brunswick, Canada
| | - Elaine Tseng
- Division of Cardiothoracic Surgery, University of California, San Francisco Medical Center, San Francisco, Calif
| | - Richard Whitlock
- Division of Cardiac Surgery, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Ming Hao Guo
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Yurdagul A, Aikawa E. Discovering a Rare Smooth Muscle Cell Population Specific to Men in Ascending Aortic Aneurysm Using Spatial Transcriptomics. Arterioscler Thromb Vasc Biol 2023; 43:2298-2300. [PMID: 37916413 PMCID: PMC10842258 DOI: 10.1161/atvbaha.123.320235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Arif Yurdagul
- Department of Molecular and Cellular Physiology, LSU Health Sciences Center in Shreveport, Shreveport, LA, 71130
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Mizrak D, Zhao Y, Feng H, Macaulay J, Tang Y, Sultan Z, Zhao G, Guo Y, Zhang J, Yang B, Eugene Chen Y. Single-Molecule Spatial Transcriptomics of Human Thoracic Aortic Aneurysms Uncovers Calcification-Related CARTPT-Expressing Smooth Muscle Cells. Arterioscler Thromb Vasc Biol 2023; 43:2285-2297. [PMID: 37823268 PMCID: PMC10842613 DOI: 10.1161/atvbaha.123.319329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Although single-cell RNA-sequencing is commonly applied to dissect the heterogeneity in human tissues, it involves the preparation of single-cell suspensions via cell dissociation, causing loss of spatial information. In this study, we employed high-resolution single-cell transcriptome imaging to reveal rare smooth muscle cell (SMC) types in human thoracic aortic aneurysm (TAA) tissue samples. METHODS Single-molecule spatial distribution of transcripts from 140 genes was analyzed in fresh-frozen human TAA samples with region and sex-matched controls. In vitro studies and tissue staining were performed to examine human CART prepropeptide (CARTPT) regulation and function. RESULTS We captured thousands of cells per sample including a spatially distinct CARTPT-expressing SMC subtype enriched in male TAA samples. Immunoassays confirmed human CART (cocaine- and amphetamine-regulated transcript) protein enrichment in male TAA tissue and truncated CARTPT secretion into cell culture medium. Oxidized low-density lipoprotein, a cardiovascular risk factor, induced CARTPT expression, whereas CARTPT overexpression in human aortic SMCs increased the expression of key osteochondrogenic transcription factors and reduced contractile gene expression. Recombinant human CART treatment of human SMCs further confirmed this phenotype. Alizarin red staining revealed calcium deposition in male TAA samples showing similar localization with human CART staining. CONCLUSIONS Here, we demonstrate the feasibility of single-molecule imaging in uncovering rare SMC subtypes in the diseased human aorta, a difficult tissue to dissociate. We identified a spatially distinct CARTPT-expressing SMC subtype enriched in male human TAA samples. Our functional studies suggest that human CART promotes osteochondrogenic switch of aortic SMCs, potentially leading to medial calcification of the thoracic aorta.
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Affiliation(s)
- Dogukan Mizrak
- Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Yang Zhao
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Hao Feng
- Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Jane Macaulay
- Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Ying Tang
- Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Zain Sultan
- Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Guizhen Zhao
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Yanhong Guo
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Jifeng Zhang
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Y. Eugene Chen
- Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
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Meccanici F, Bom A, Knol W, Gökalp A, Thijssen C, Bekkers J, Geuzebroek G, Mokhles M, van Kimmenade R, Budde R, Takkenberg J, Roos-Hesselink J. Male-female differences in thoracic aortic diameters at presentation of acute type A aortic dissection. IJC HEART & VASCULATURE 2023; 49:101290. [PMID: 37942298 PMCID: PMC10628350 DOI: 10.1016/j.ijcha.2023.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023]
Abstract
Background Acute type A aortic dissection (ATAAD) is a highly lethal event, associated with aortic dilatation. It is not well known if patient height, weight or sex impact the thoracic aortic diameter (TAA) at ATAAD. The study aim was to identify male-female differences in TAA at ATAAD presentation. Methods This retrospective cross-sectional study analysed all adult patients who presented with ATAAD between 2007 and 2017 in two tertiary care centres and underwent contrast enhanced computed tomography (CTA) before surgery. Absolute aortic diameters were measured at the sinus of Valsalva (SoV), ascending (AA) and descending thoracic aorta (DA) using double oblique reconstruction, and indexed for body surface area (ASI) and height (AHI). Z-scores were calculated using the Campens formula. Results In total, 59 % (181/308) of ATAAD patients had CT-scans eligible for measurements, with 82 female and 99 male patients. Females were significantly older than males (65.5 ± 12.4 years versus 60.3 ± 2.3, p = 0.024). Female patients had larger absolute AA diameters than male patients (51.0 mm [47.0-57.0] versus 49.0 mm [45.0-53.0], p = 0.023), and larger ASI and AHI at all three levels. Z-scores for the SoV and AA were significantly higher for female patients (2.99 ± 1.66 versus 1.34 ± 1.77, p < 0.001 and 5.27 [4.38-6.26] versus 4.06 [3.14-5.02], p < 0.001). After adjustment for important clinical factors, female sex remained associated with greater maximal TAA (p = 0.019). Conclusion Female ATAAD patients had larger absolute ascending aortic diameters than males, implying a distinct timing in disease presentation or selection bias. Translational studies on the aortic wall and studies on growth patterns should further elucidate these sex differences.
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Affiliation(s)
- F. Meccanici
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - A.W. Bom
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - W.G. Knol
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - A.L. Gökalp
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - C.G.E. Thijssen
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - J.A. Bekkers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - G.S.C. Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - M.M. Mokhles
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiothoracic Surgery, Utrecht University Medical Centre, Utrecht, Netherlands
| | - R.R.J. van Kimmenade
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - R.P.J. Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - J.J.M. Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - J.W. Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
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7
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Katsarou M, Mandigers TJ, Berczeli M, Mujeeb Zubair M, Belvroy VM, Bissacco D, van Herwaarden JA, Trimarchi S, Bismuth J. Sex-Specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair: A Retrospective Cohort Study. J Endovasc Ther 2023:15266028231210228. [PMID: 37936418 DOI: 10.1177/15266028231210228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
OBJECTIVE In many studies on aortic disease, women are underrepresented. The present study aims to assess sex-specific morphometric differences and gain more insight into endovascular treatment of the ascending aorta (AA) and arch. METHODS Electrocardiogram-gated cardiac computed tomography scans of 116 consecutive patients who were evaluated for transcatheter aortic valve replacement were retrospectively reviewed. Measurements of the AA and aortic arch were made in multiplanar views, perpendicular to the semi-automatic centerline. Multiple linear regression analysis was performed to identify predictors affecting AA and aortic arch diameter in men and women. Propensity score matching was used to investigate whether sex influences aortic morphology. RESULTS In both sexes, body surface area (BSA) was identified as a positive predictor and diabetes as a negative predictor for aortic diameters. In men, age was identified as a positive predictor and smoking as a negative predictor for aortic diameters. Propensity score matching identified 40 pairs. Systolic and diastolic mean diameters and AA length were significantly wider in men. On average, male aortas were 7.4% wider than female aortas, both in systole and diastole. CONCLUSIONS The present analysis demonstrates that, in women, increased BSA is associated with increased aortic arch diameters, while diabetes is associated with decreased AA and arch diameters. In men, increased BSA and age are associated with increased AA and arch diameters, while smoking and diabetes are associated with decreased AA and arch diameters. Men were confirmed to have 7.4% greater AA and arch diameters than women. CLINICAL IMPACT Men had 7.4% greater ascending aorta and arch diameters than women in a retrospective cohort, gated computed tomography-based study of 116 patients. Sex-specific differences in ascending aortic and arch size should be considered by aortic endovascular device manufacturers and physicians when developing ascending and arch endografts and planning aortic interventions.
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Affiliation(s)
- Maria Katsarou
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Milan, Italy
| | - Tim J Mandigers
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Milan, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marton Berczeli
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Department of Vascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - M Mujeeb Zubair
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Viony M Belvroy
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daniele Bissacco
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Santi Trimarchi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Jean Bismuth
- Division of Vascular Surgery, LSU School of Medicine, New Orleans, LA, USA
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8
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Hui DS, Chen EP, DeAnda A, Girardi LN, Kim KM, Woo YJ, Tseng EE, Preventza O. Perspectives on the 2022 joint guidelines on the diagnosis and management of aortic disease. J Thorac Cardiovasc Surg 2023; 166:1413-1417. [PMID: 37543165 DOI: 10.1016/j.jtcvs.2023.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Dawn S Hui
- Department of Cardiothoracic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Tex.
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Abe DeAnda
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, The University of Texas Medical Branch-Galveston, Galveston, Tex
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Tex
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Elaine E Tseng
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco Medical Center and San Francisco VA Medical Center, San Francisco, Calif
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
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Hui DS. Commentary: A Premature Presumption. Semin Thorac Cardiovasc Surg 2022; 35:309-310. [DOI: 10.1053/j.semtcvs.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 11/11/2022]
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