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CC BY 4.0 · Thorac Cardiovasc Surg
DOI: 10.1055/a-2239-1741
Original Basic Science

Sex Differences in the Histopathology of Acute Type A Aortic Dissections

Nimrat Grewal
1   Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, Netherlands
,
Onur Baris Dolmaci
1   Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, Netherlands
2   Department of Cardiothoracic Surgery, Leiden Universitair Medisch Centrum, Leiden, Netherlands
,
Robert JM Klautz
1   Department of Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, Netherlands
,
Robert E. Poelmann
3   Animal Sciences and Health, Leiden University, Leiden, Netherlands
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Abstract

Background Although sex-related differences in cardiovascular surgery outcomes have increasingly garnered attention in the past decades, knowledge about sex disparities in the pathophysiology of acute type A aortic dissections (ATAADs) remains sparse. In this study, we evaluate the histopathologic and atherosclerotic lesions in female and male ATAAD patients.

Methods A total of 68 patients were studied: 51 ATAAD patients (mean age: 62.5 ± 10.8 years; 49% women) and 17 control patients (mean age: 63 ± 5.5 years; 53% women). Cardiovascular risk factors were assessed clinically. Intimal and medial histopathological features were systematically evaluated in all.

Results Compared to the control group, all ATAAD patients showed significantly more elastic fiber pathology, mucoid extracellular matrix accumulation, smooth muscle cell nuclei loss, and overall medial degeneration (p < 0.0001). The tunica intima was significantly thinner in the ATAAD patients than in the control group (p < 0.023), with the latter exhibiting significantly more progressive atherosclerotic lesions than the former. No difference in medial vessel wall pathology was seen between female and male patients. As compared to male ATAAD patients, atherosclerotic lesions were more severe in female ATAAD patients, independent of age and the cardiovascular risk factor hypertension.

Conclusion All ATAAD patients had a significantly thinner tunica intima and significantly diseased tunica media compared to the control patients. Our results suggest that the severity of medial aortic pathology is not sex specific in ATAAD patients. Intimal differences between females and males could, however, be considered a potential risk factor for the development of an aortic dissection.

Keywords

aorta - dissection - sex differences - histopathology


Publication History

Received: 28 June 2023

Accepted: 03 January 2024

Accepted Manuscript online:
05 January 2024

Article published online:
12 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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