| Objective: To evaluate the effect of the remodeling and clinical characteristics of theaorta as related to size of ascending aortic aneurysm and sex. To analyse the effect of sexand size difference in predicting the postoperative outcome by different risk-model-evaluated scoring system. Methods: Between2006and2013, the mechanicalcharacteristics of the aorta were measured by transesophageal echocardiography(TEE) atthe time of surgery in167patients with ascending aortic aneurysm undergoing selectivesurgery and in180control patients with normal aortas undergoing coronary artery bypass grafting. According to size,four subgroups were divided. Four parameters were measuredin all patients: aortic diameter in end-systole and end-diastole, and aortic wall thickness inend-systole and end-diastole. These were used to calculate mechanical characteristics ofthe aorta from standard equations. Aortic distensibility reflects the elastic qualities of theaorta. Aortic wall stress reflects the disrupting force experienced within the aortic wall.Incremental elastic modulus indicates loss of elasticity reserve.Clinical characteristics ofthe aortic aneurysm and sex difference were gathered including the pre-,peri-andpost-operative data were measured in4h,8h,12h and24h respectively.Postoperative peakcreatine kinase MB levels scoring systems were used to evaluate the prognostic effect insize-specific aortic aneurysm and sex.24months follow-ups were carried out aftersurgery.Results: Compared with the control group, mean end-systolic in aneurysmalgroups and end-diastolic diameter in same sex-group were shorted significantly,whilemore enlarged in men than in women.（P<0.05）.Compared with women in samesex-groups,there were significantly differences with respect to the size of meanend-systolic and end-diastolic wall thickness （P>0.05）.However,mean end-systolic andend-diastolic wall thickness in5-6cm subgroup was significantly thinner than in thecontrol group,<4cm subgroup and4-5cm subgroup,especially thinnest when comparingbetween5-6cm and>6cm subgroup.There were significantly differences between womenand men according to the mechanical characteristics of aortic distensibility（P<0.05）,while no difference in <4cm and4-5cm subgroup compared with the controlgroup（P>0.05）.Aortic distensibility was obviously decreased in5-6cm subgroupcompared with other groups,especially in>6cm subgroup.（P<0.05）.With the increase inaortic diameter, there were obviously differences between the control and aneurysmalgroups according to the mechanical characteristics of wall stress（92.51/90.51VS157.8/149.9） and incremental elastic modulus （1.18/1.16VS1.93/1.87）.andfurthermore,wall stress had sex difference in>6cm subgroup （P<0.05）.There werestrikingly differences between the control and aneurysmal groups in accordance withincremental elastic modulus（.P<0.05）.Ahigh correlation between aortic distensibility andthe increase in aortic diameter was found in men （r2=0.28p<0.05,n=167）, while no correlation in women.Similarly,a high correlation between incremental elastic modulusand the increase in aortic diameter was found in men and in women respectively（r2=0.29/0.24p<0.05,n=167).Hemopericardium according to the preoperative outcome of Doppler ultrasonicechocardiography(UCG) was obviously increased in5-6cm and>6cm grouprespectively,compared with <5cm group.There were significantly differences in5-6cmand>6cm group on clinical characteristics of aortic dissection and intima crevasse,whilenot seen in <5cm group.There were significantly sex differences on morbidity in different-sizedascending aortic aneurysm in5-6cm and>6cm subgroup respectively （p<0.05）.Therewere also sex differences in the peak CK-MB level of different time points. women issignificantly higher than men（p<0.05）.Ahigh correlation between the length of CPB andICU stay and hospital stay with the increase in level of CK-MB was found.Similarly，therewere correlation between the length of hospital stay and the increase in level ofCK-MB.Compared with men,the early postoperative outcome and complication, such asnew-set POAF,lesion infection, in-hospital mortality and the length of hospital stay, wererelatively higher in women.The unadjusted in-hospital mortality rate was2.6%in men and5.1%in women.This difference was significant on univariate analysi（sP<0.001）but not onmultivariate analysis（P=0.762）.After adjusting for difference in patient variables,femalesex was not independently associated with long-tern surviva（lP=0.632，0.091）. Accordingto risk scores of Charlson index and EuroSCORE, women’s prognosis was poorer thanmen,while better in DASI. In terms of MSSS assessment on postoperative physical andmental health, men were better than women.After adjusting sex difference,24monthssurvival rate were decreased obviously in women.Conclusion: There may also be sexdifferences in the remodeling and biomechanical characteristics of the aorta with anincrease in aortic diameter.We may accurately predict and calculate the biomechanicalcharacteristics of the aorta by transesophageal echocardiography. Such assessmentshould lead to increased safety of our patients who were at risk of rupture or dissection,onthe basis of accessible and reproducible biomechanical data.Woman was not independent risky factors.Differences in gender and aortic diameter size was likely to be risk factors ofclinical features.Clinical characteristics were urgent and progressive in women.Differentrisk evaluating system showed that women had a higher mortality rate and poorer outcomethan men. |
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