背景:本研究的目的是全面比较男性和女性急性A型主动脉夹层(ATAAD)修复后的结局。
方法:PubMed,Medline,和WebofScience被两位作者系统地搜索了1月1日发表的研究,2000年至5月10日,2021年。总的来说,筛选了2405篇文章,16人被纳入本审查。对汇编数据进行Meta分析。
结果:汇总估计表明手术没有差异(比值比(OR)1.00,95%置信区间(CI)0.59-1.67,P=0.99,I2=52%),住院(OR0.78,95%CI0.56-1.08;P=0.13,I2=57%),性别之间的30天死亡率(OR1.09,95%CI0.83-1.43,P=0.52,I2=45%)。然而,男性5年死亡率显著降低(OR0.71,95%CI0.51-1.00,P=0.05,I2=45%).术后卒中发生率无性别差异(OR1.07,95%CI0.86-1.33,P=0.54,I2=0%),心房颤动(OR0.99,95%CI0.82-1.19,P=0.92,I2=0%),以及肠系膜或肢体缺血(OR0.73,95%CI0.22-2.43,P=0.61,I2=77%;OR0.83,95%CI0.30-2.30,P=0.72,I2=76%,分别)。男性急性肾功能衰竭和再手术的发生率显著升高(OR1.35,95%CI1.16-1.56,P=0.0001,I2=29%;OR1.40,95%CI1.09-1.81,P=0.010,I2=42%)。
结论:综合分析表明,早期死亡率在性别之间没有差异;然而,后期结果有利于男性。男女之间术前表现和后续手术选择的差异可能导致晚期结局的差异。ATAAD手术治疗的决策应考虑性别特异性危险因素。
BACKGROUND: The objective of this study is to provide a comprehensive comparison of outcomes following acute type A aortic dissection (ATAAD) repair in males and females.
METHODS: PubMed, Medline, and Web of Science were systematically searched by two authors for studies published from January 1st, 2000, to May 10th, 2021. Overall, 2405 articles were screened, and 16 were included in this
review. Meta-analysis of the compiled data was performed.
RESULTS: Pooled estimates indicated no difference in operative (odds ratio (OR) 1.00, 95% confidence interval (CI) 0.59-1.67, P=0.99, I2=52%), in-hospital (OR 0.78, 95% CI 0.56-1.08; P=0.13, I2=57%), and 30-day mortality (OR 1.09, 95% CI 0.83-1.43, P=0.52, I2=45%) between the sexes. However, males had significantly reduced 5-year mortality rates (OR 0.71, 95% CI 0.51-1.00, P=0.05, I2=45%). There was no difference between sexes in rates of postoperative stroke (OR 1.07, 95% CI 0.86-1.33, P=0.54, I2=0%), atrial fibrillation (OR 0.99, 95% CI 0.82-1.19, P=0.92, I2=0%), as well as mesenteric or limb ischemia (OR 0.73, 95% CI 0.22-2.43, P=0.61, I2=77%; OR 0.83, 95% CI 0.30-2.30, P=0.72, I2=76%, respectively). Males did experience significantly increased rates of acute renal failure and reoperation (OR 1.35, 95% CI 1.16-1.56, P=0.0001, I2=29%; OR 1.40, 95% CI 1.09-1.81, P=0.010, I2=42%).
CONCLUSIONS: Composite analysis indicates that early mortality does not differ between the sexes; however, late outcomes favor males. Differences in preoperative presentation and subsequent procedure selection between the sexes likely contribute to the disparity in late outcomes. Decision-making for surgical treatment of ATAAD should account for sex-specific risk factors.