Sex Specific Differences in the Management of Descending Thoracic Aortic Aneurysms: Systematic Review with Meta-Analysis.

Ulug, Pinar; Powell, Janet T; Warschkow, Rene; Von Allmen, Regula S. (2019). Sex Specific Differences in the Management of Descending Thoracic Aortic Aneurysms: Systematic Review with Meta-Analysis. European journal of vascular and endovascular surgery EJVES, 58(4), pp. 503-511. Elsevier 10.1016/j.ejvs.2019.04.022

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OBJECTIVES To assess sex specific differences in 30 day mortality, length of hospital stay, and adverse neurological events following repair of intact degenerative descending thoracic aortic aneurysms (TAAs), by either thoracic endovascular (TEVAR) or open repair. METHODS MEDLINE, Embase, and CENTRAL databases were searched from 2005 to 2019, using ProQuest Dialog. 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 neurological events. Forest plots with random effects meta-analysis to provide odds ratios (OR) were used for primary assessment. RESULTS For TEVAR, seven studies were identified, including 2758 women and 4674 men; of these studies six were eligible for the primary outcome of 30 day mortality, including 1756 women and 2619 men. There were 94/1756 deaths in women and 82/2619 deaths in men, 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 standardised 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 significant factor in these differences. Stroke rate was not different between the sexes. For open repair only a single study, with national coverage, was identified: this study reported similar 30 day mortality in men and women. CONCLUSIONS In the management of intact degenerative descending TAAs, 30 day mortality after TEVAR appears to be much higher in women than men with no reasons for this difference identified. However, for open repair there is a lack of contemporary evidence owing to insufficient recent data.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Von Allmen, Regula Sybille

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1078-5884

Publisher:

Elsevier

Language:

English

Submitter:

Claudia Stalder

Date Deposited:

07 Aug 2019 10:15

Last Modified:

24 Oct 2019 02:21

Publisher DOI:

10.1016/j.ejvs.2019.04.022

PubMed ID:

31371067

Uncontrolled Keywords:

Descending thoracic aortic aneurysm Length of stay Operative mortality Sex TEVAR

BORIS DOI:

10.7892/boris.132338

URI:

https://boris.unibe.ch/id/eprint/132338

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