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Editor's Choice - Sex Specific Differences in the Management of Descending Thoracic Aortic Aneurysms: Systematic Review with Meta-Analysis

Pinar Ulug, Janet T Powell, Rene Warschkow & Regula Von Allmen

abstract

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.
   
citation Ulug P, Powell J T, Warschkow R, von Allmen R. Editor's Choice - Sex Specific Differences in the Management of Descending Thoracic Aortic Aneurysms: Systematic Review with Meta-Analysis. Eur J Vasc Endovasc Surg 2019; 58:503-511.
   
type journal paper/review (English)
date of publishing 29-07-2019
journal title Eur J Vasc Endovasc Surg (58/4)
ISSN electronic 1532-2165
pages 503-511
PubMed 31371067
DOI 10.1016/j.ejvs.2019.04.022