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Background/Objectives: Recent studies show conflicting results regarding sex-related differences in outcomes following aortic surgery. This study primarily evaluated 20-year mortality rates, along with 30-day and one- and five-year rates, and postoperative complications in female and male patients who underwent elective and acute ascending aortic surgery at a tertiary care centre. Methods: This retrospective observational study analysed data from 676 adult patients who underwent ascending aortic surgery in Amsterdam UMC, between January 2001 and December 2020. Descriptive statistics, Fisher's Exact test, Kaplan–Meier survival analysis, and logistic regression were used to assess differences in mortality rates. Results: Patient characteristics for elective and acute procedures were different. Females were generally older (elective: 69 vs. 62 years, p < 0.001, acute: 70 vs. 62 years, p = 0.002), with smaller body surface area (elective/acute: 1.8 vs. 2.1 m2, p < 0.001), lower preoperative haemoglobin (elective: 8.3 vs. 8.9 mmol/L, p < 0.001, acute: 7.8 vs. 8.4 mmol/L, p < 0.001) and estimated glomerular filtration rate (elective: 64 vs. 91 mL/min, p < 0.001; acute: 67 vs. 83 mL/min, p = 0.004). Females undergoing elective procedures had a lower body mass index (25.0 vs. 26.6 kg/m2, p = 0.006), better left ventricle function (p = 0.048) and higher incidence of chronic obstructive pulmonary disease (15 vs. 8%, p = 0.032). In elective procedures, the 20-year mortality rate (49% vs. 30%, p < 0.001) was significantly higher in females, especially those under 60 years (OR of 3.158 [1.2–8.6], p = 0.024). Mortality rates up to one year were comparable. Five-year mortality rate (26% vs. 16%, p = 0.027) was higher. Females had longer ventilation times (32% vs. 15%, p < 0.001) and intensive care unit stays (2 vs. 1 days, p = 0.005). For acute procedures, morbidity and mortality rates were comparable between sexes. Conclusions: Females under 60, undergoing elective ascending aortic surgery showed higher long-term all-cause mortality rates. Implementing sex-specific management strategies and extended follow-up could be essential for improving outcomes in this group. [ABSTRACT FROM AUTHOR]

There is a well-documented sex disparity in clinical research worldwide. Historically, most studies were conducted predominantly on male participants. This raises concerns about the generalisability and extrapolability of the findings to female patients, who exhibit different physiological and pharmacological responses. The present study aimed to investigate whether participation willingness in prospective clinical trials, having no sex-specific restrictions on inclusion, was disparate for both sexes. This observational retrospective study utilised prospectively collected screening logs of clinical trials conducted in the Department of Anaesthesiology, Amsterdam UMC, over a 5-year period from 1 January 2019 to 31 December 2023. The Institutional Review Board of the Amsterdam UMC, situated at AMC, verified on 15 March 2023 that this study did not fall within the scope of the Medical Research involving Human Subjects Act (W23_111#23.136). The study population included adult patients of both sexes who were approached for participation in prospective interventional and observational clinical trials. Importantly, only clinical trials were included where both sexes had equal opportunity to participate, with no other sex-specific restrictions. To ensure data integrity, any patients who were approached for multiple trials were included only once, to avoid double-counting of individuals in the final analysis. The preliminary data analysis included a total of 5 145 approached patients, of whom 3 995 (78%) were willing to participate in a study and 1 150 (22%) refused study participation. The study population had a median age of 62 years with a range from 18 to 96 years. Of the 5 145 patients approached, 2 509 (49%) were male, and 2 636 (51%) were female. However, when examining participation rates by sex, 2 018 (80%) of the males approached were willing to take part in a study, while only 1 977 (75%) of the females approached were inclined to do so. The difference in participation rates between males and females was statistically significant (p<.001). This study showed that when no sex-specific restrictions are placed on participation, the sexes were approached almost equally. However, when investigating effective participation rates by sex, a statistically significant difference is seen, where males participate more often, compared to females. It is important to understand the underlying factors that contribute to this observed sex disparity. Researchers should strive to ensure that the representation of males and females in clinical trials is proportional to the prevalence of the disease or condition being studied, in order to enhance the applicability of the research findings to the diverse patient population. [ABSTRACT FROM AUTHOR]

Female sex is associated with increased mortality within Coronary Artery Bypass Grafting and valve-surgery. Recent literature fails to identify the same association for aortic surgery but less is known of the long term mortality (>5 years). The objective of this study was to compare short-term (30-day, 1-year and 5-year) and long-term (20-year) mortality between female and male patients undergoing aortic surgery. This retrospective observational study analysed prospectively collected quality assurance data of patients who underwent cardiac surgery in the Amsterdam UMC, between January 2001 and December 2020. All adult patients (>18 years) undergoing aortic surgery were included. Aortic surgery included all acute and elective procedures, in which any part of the thoracic aorta was involved. Descriptive statistics were used for incidence rates, Fisher's Exact test for the assessment of differences in mortality, and Kaplan-Meier and Cox Proportional Hazard regression for analysing and adjusting for potential confounders. Preliminary results: A total of 11 675 patients were admitted for cardiac surgery. Of these, 675 patients underwent aortic surgery procedures, with 219 (32%) females and 456 (68%) males. Females were significantly older at the time of surgery compared to males (67±11 years vs. 61±12 years, p<.001), had a higher rate of chronic obstructive pulmonary disease (p=.035) and a lower eGFR (p<.001). Males had a higher rate of abnormal left ventricular function (p=.046) and previous heart surgery (p=.014), while females had a smaller body surface area (p<.001). No significant difference in surgical urgency was observed between females and males (p=.868). Mortality at 30 days (29 (13%) vs. 56 (12%), p=.712), one year (42 (19%) vs. 79 (17%), p=.592) and five years (63 (29%) vs. 107 (24%), p=.155) was similar between sexes. Long term mortality at 20 years was significantly higher in females compared to males (107 (49%) vs. 172 (38%), p=.007). After adjusting this analysis for age, Cox Proportional Hazards regression did not find a significant association between sex and mortality (odds ratio=0.988, confidence interval [0.769-1.268], p=.922). The short- and intermediate-term mortality rates at 30 days, one year, and five years between females and males, where similar. The significantly higher long-term mortality at 20 years in females, suggests a potential long-term survival discrepancy which may be influenced by factors other than sex alone. Females undergoing aortic surgery were older than males, indicating a potential age-related difference in the patient population. Future research should focus on identifying factors responsible for the apparent sex disparity in cardiac surgery. [ABSTRACT FROM AUTHOR]