Sex-Based Differences in Dissection Patterns and Surgical Strategies in Tear-Oriented Repair for Acute Type A Aortic Dissection: A Single-Center Retrospective Study

PURPOSE: This study aimed to evaluate sex-based differences in the clinical characteristics, aortic anatomy, surgical strategies, and outcomes of patients undergoing emergency surgery for acute Stanford type A aortic dissection (AAAD). METHODS: We retrospectively analyzed 148 consecutive patients (82 males and 66 females) who underwent surgery for AAAD at a single center. We compared their backgrounds, entry tear locations, operative procedures, and postoperative outcomes. Kaplan-Meier analysis assessed long-term survival and freedom from re-intervention. RESULTS: Female patients were significantly older than male patients, more likely to have ascending aortic entry tears, and more often treated by hemiarch replacement. Male patients underwent total arch replacement more frequently because of arch or distal entry tears and had a higher incidence of iliac artery involvement, indicating more extensive distal dissection. In-hospital mortality, major postoperative complications, long-term survival, and freedom from re-intervention showed no significant sex-based differences. CONCLUSION: In female patients, the predominance of ascending entry tears allows less extensive surgery without compromising outcomes. Therefore, when dissection patterns are suitable, emergent surgery is appropriate even in elderly female patients.