Available online 9 September 2023

Disparities in outcomes for patients with cardiovascular disease and those undergoing cardiac or vascular operations are well-established. These disparities often span several dimensions and persist despite advancements in medical and surgical care, with gender being among the most pervasive. Specifically, female gender has been implicated as a predictor of poor outcomes in both patients with acute type A aortic dissections (ATAAD) and type B aortic dissections (TBAD). For instance, Nienaber et al demonstrated, using the International Registry of Acute Aortic Dissection (IRAD) database, that women with acute aortic dissection – including ATAAD and TBAD that were either medically or surgically managed – had a 40% higher odds of in-hospital mortality than men. Notably, both types of acute aortic dissections afflict men more commonly than women and can be life-threatening without prompt, appropriate treatment. The underlying mechanisms for these disparities are unclear but thought to be multifactorial. The association of gender with patterns of disease and outcomes in patients with ATAAD or TBAD is remains unclear with conflicting reports from different studies. Thus, we sought to review the literature regarding gender disparities in ATAAD and TBAD patients.

Disparities in outcomes for patients with cardiovascular disease and those undergoing cardiac or vascular operations are well-established. These disparities often span several dimensions and persist despite advancements in medical and surgical care, with gender being among the most pervasive. Specifically, female gender has been implicated as a predictor of poor outcomes in both patients with acute type A aortic dissections (ATAAD) and type B aortic dissections (TBAD).1,2 For instance, Nienaber

The PubMed/MEDLINE, Embase, and Scopus databases were searched from their inception until June 15, 2023, for articles relevant to the objectives of this scoping review. Specifically, the database searches were performed with the “only in English” limit for the following search terms: “gender” and “type A aortic dissection.” The initial searches produced 1,199 total articles, including 391 articles from PubMed/MEDLINE, 348 articles from Embase, and 460 articles from Scopus (Figure 1). Duplicate

All 15 included studies were retrospective (Table 1).1,15-28 Eight were single institution studies while the other seven were national or international multicenter or registry studies, with many assessing European populations. Thirteen of the 15 included studies focused their analyses on patients undergoing ATAAD repair, while the other two included patients with ATAAD managed medically or surgically. Almost all the papers were published in the last five years, suggesting a surge of interest in

These scoping reviews assessing gender disparities in ATAAD and TBAD patients revealed several notable findings as well as existing gaps in the literature. In ATAAD and TBAD, males are more commonly affected than females by a 2:1 margin but female patients are significantly older than males. Given the well-established association between increased age and ATAAD as well as TBAD mortality, this likely predisposes female patients to worse outcomes. Further, for ATAAD, female patients may be more

Nienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection. Circulation. 2004;109(24):3014-3021.

Bossone E, Carbone A, Eagle KA. Gender Differences in Acute Aortic Dissection. J Pers Med. 2022;12(7):1148. Published 2022 Jul 15.

Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013;127(20):2031-2037.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2023 Published by Elsevier Inc.