Disparities in outcomes for patients with cardiovascular disease and those undergoing cardiac or vascular operations are well-established. These disparities often span several dimensions and persist despite advancements in medical and surgical care; sex is among the most pervasive. Specifically, females sex has been implicated as a predictor of poor outcomes in patients with acute type A aortic dissections (ATAAD) and type B aortic dissections (TBAD) [1,2]. For instance, Nienaber et al [1], using the International Registry of Acute Aortic Dissection database, found that females with acute aortic dissection—including ATAAD and TBAD that were managed either medically or surgically—had 40% higher odds of in-hospital mortality than men. Notably, both types of acute aortic dissections affect men more commonly than females and can be life-threatening without prompt, appropriate treatment [1,2]. The underlying mechanisms for these disparities are unclear but are thought to be multifactorial.

ATAAD, which affects between 2 and 4 patients per 100,000, is among the most morbid of cardiovascular pathologies. Up to one-half of these patients die before reaching the hospital and, for those surviving to hospitalization, between one-fourth and one-half die within 30 days [3], [4], [5], [6], [7]. However, for patients that survive their admission, the 5-year survival rate is approximately 85% [3]. Well-established risk factors for ATAAD mortality include increasing age; hypertension, particularly if uncontrolled; smoking; and prior aortic surgery, among others [3], [4], [5], [6], [7]. ATAAD incidence has been associated with increased age and male sex, although females tend to be older at the time of their presentation [3,5].

TBAD has an incidence of approximately 12 in 100,000 patients per year and accounts for nearly 30% of aortic dissections [8]. In the 30% of patients with TBAD who present with complicated dissections with rupture or malperfusion, their perioperative mortality decreased considerably in the endovascular era, but remains approximately 10% [5]. Of the 70% of patients who present with uncomplicated dissections, their in-hospital mortality rate is just 10%; treatment goals, medical and endovascular/surgical, are aimed at preventing dissection progression and aneurysm degeneration [9]. Previous reports have highlighted differences in outcomes between male and females patients who undergo elective and nonelective treatment of degenerative aneurysms [1,[8], [9], [10], [11], [12], [13]]. However, the association between sex and outcomes in patients with ATAAD or TBAD is not clear, with conflicting reports from different studies. Moreover, the relationship between sex and patterns of disease for patients with ATAAD or TBAD is not well understood. Thus, we sought to review the literature regarding sex disparities in patients with ATAAD and TBAD.