Sex-based outcomes after thoracic endovascular aortic repair: a systematic review and meta-analysis

Yixiao Zhang; Yuchong Zhang; Yulin Wang; Hao Lai; Weiguo Fu; Chunsheng Wang; Lixin Wang; Qiang Ji

doi:10.1016/j.jvs.2024.04.024

Sex-based outcomes after thoracic endovascular aortic repair: a systematic review and meta-analysis

J Vasc Surg. 2024 Apr 13:S0741-5214(24)00986-8. doi: 10.1016/j.jvs.2024.04.024. Online ahead of print.

Authors

Yixiao Zhang¹, Yuchong Zhang², Yulin Wang¹, Hao Lai¹, Weiguo Fu², Chunsheng Wang³, Lixin Wang⁴, Qiang Ji⁵

Affiliations

¹ Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
² Department of Vascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China; Vascular Surgery Institute of Fudan University, 180 Fenglin Road, Shanghai, 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China.
³ Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China; Shanghai Municipal Institute for Cardiovascular Diseases, 1609 Xietu Road, Shanghai, 200032, China.
⁴ Department of Vascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China; Vascular Surgery Institute of Fudan University, 180 Fenglin Road, Shanghai, 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China. Electronic address: zscardiacsurgery@163.com.
⁵ Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. Electronic address: zscardiacsurgery@163.com.

PMID: 38621637
DOI: 10.1016/j.jvs.2024.04.024

Abstract

Objective: As it remains unclear whether there are sex-based differences in clinical outcomes after thoracic endovascular aortic repair (TEVAR), this meta-analysis aimed to evaluate differences in early outcomes and overall survival between female and male patients who underwent TEVAR.

Methods: PubMed, Embase, Web of Science, and Cochrane Central databases were searched for eligible studies published through June 10, 2023, that reported sex-based differences in clinical outcomes after TEVAR. The primary outcome was operative mortality; second outcomes included stroke, spinal cord ischemia (SCI), acute kidney injury (AKI), hospital length of stay (LOS), and overall survival. Patient characteristics, operative data, and early outcomes were aggregated using the random-effects model, presenting pooled risk ratio (RR) or standardized mean difference (SMD) along with their corresponding 95% confidence intervals (CIs). Overall survival was assessed by reconstructing individual patient data to generate sex-specific pooled Kaplan-Meier curves. This study was registered in PROSPERO (CRD42023426069).

Results: Out of the 1785 studies retrieved, 14 studies met all eligibility criteria, encompassing a total of 17374 patients, comprising 5026 females and 12348 males. Female patients were older, had a smaller maximum aortic diameter, had lower rates of smoking and coronary artery disease, and had higher rates of anemia. Intraoperatively, females were more likely to use iliac conduits and require blood transfusions. There were no sex-based differences in operative mortality (RR: 1.12, 95% CI: 0.90-1.40; p=0.309), stroke (RR: 1.14, 95% CI: 0.95-1.38; p=0.165), SCI (RR: 1.33, 95% CI: 0.83-2.14; p=0.234), AKI (RR: 0.78, 95% CI: 0.52-1.17; p=0.228), and hospital LOS (SMD: 0.09, 95% CI: -0.03 to 0.20; p=0.141). Pooled Kaplan-Meier estimates showed a worse overall survival in female patients compared with male patients (87.2% vs. 89.8% at 2-year, log-rank p=0.001).

Conclusions: Among patients treated by TEVAR, female sex was not associated with increased risk of operative mortality or major morbidity. However, females exhibited a lower overall survival after TEVAR compared with males.

Keywords: Meta-analysis; Sex difference; Thoracic aortic disease; Thoracic endovascular aortic repair.

Publication types

Review