September 25, 2019
Sex-Specific Differences Evaluated in Management of Descending TAA
September 26, 2019—In European Journal of Vascular and Endovascular Surgery (2019;58:503–511), Pinar Ulug, MD, et al published findings from a systematic review with meta-analysis to evaluate sex-specific differences in the management of descending thoracic aortic aneurysms (TAAs).
The investigators assessed sex-specific differences in 30-day mortality, length of hospital stay, and adverse neurologic events after repair of intact degenerative descending TAAs by either thoracic endovascular aortic repair (TEVAR) or open repair.
As summarized in EJVES, ProQuest Dialog was used to search MEDLINE, Embase, and CENTRAL databases from 2005 to 2019. The reviews were registered in PROSPERO (CRD42017020026) and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
The primary outcome was 30-day mortality. Secondary outcomes were length of hospital stay and adverse neurologic events. For primary assessment, the study used forest plots with random-effects meta-analysis to provide odds ratios (ORs).
Seven studies—composed of 2,758 women and 4,674 men—were identified for TEVAR. Of these studies, six were eligible for the primary outcome of 30-day mortality, including 1,756 women and 2,619 men.
The investigators reported the following:
- There were 94 deaths among the women (n = 1,756) and 82 deaths among the men (n = 2,619), yielding a pooled 30-day mortality of 5% (95% confidence interval [CI], 3–7) in women and 3% (95% CI, 2–4) in men (OR, 1.75; 95% CI, 1.29–2.38).
- Length of hospital stay was longer in women, with a standardized mean difference of 0.3 days (95% CI, 0.14–0.47; six studies). Meta-regression analysis did not identify the slightly older age of women as a significant factor in these differences.
- Stroke rate was not different between the sexes.
They identified only one open-repair study with national coverage; this study reported similar 30-day mortality in men and women.
In EJVES, the investigators concluded that in the management of intact degenerative descending TAAs, 30-day mortality after TEVAR appears to be much higher in women than men with no identified reasons for this difference. However, they noted that for open repair there is a lack of contemporary evidence owing to insufficient recent data.