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(Toronto, February 13, 2019) – A new research paper that compares outcomes of men and women following surgery on their heart's aorta has found women experience worse outcomes than men.

Researchers examined three different outcomes: early death, stroke and a composite of complications. In every case, women were more likely to wind up sicker.

The study, published in February 2019's sex-themed issue of Circulation, found if you're a woman, you're two times more likely to experience a stroke or death following surgery. More specifically, women are 80 per cent more likely to die, 90 per cent more likely to experience a stroke, and 40 per cent more likely to experience a complication.

"We controlled for patients' age, weight, pre-operative health, co-morbidities, and when we took all of that into consideration, going into aortic arch surgery, you're slightly less than twice as likely to die if you're a woman," explains Dr. Jennifer Chung, cardiac surgeon and scientist at the University Health Network's (UHN) Peter Munk Cardiac Centre. Dr. Chung is the lead author on the paper.

Dr. Michael Chu, clinician scientist at Lawson Health Research Institute and cardiac surgeon at London Health Sciences Centre, says these findings are consistent with other recent findings in cardiovascular medicine that also suggest women experience worse outcomes. Dr. Chu served as the paper's senior investigator.

"Historically, this issue has not been well addressed. Sex-specific considerations are paramount in cardiovascular medicine, and we investigated this in the largest study to-date, looking at outcomes after thoracic aortic surgery," he explains. "Similar to other areas in cardiovascular medicine, our study suggests women present later in the disease process perhaps with atypical symptoms, like nausea.  This may explain the difference in outcome between women and men in emergency situations, when patients experience something like an aortic dissection, or a ruptured aorta. But even still – we analyzed both situations – when people came for elective versus emergency surgery – and women still did worse either way."

An aortic dissection is an emergency, and can initially present like a heart attack or a stroke. Symptoms include sudden chest pain, dizziness, nausea and challenges walking and speaking.

Dr. Chung stresses this study should prompt further research that will help clinicians figure out why exactly women are suffering from poorer outcomes than men. "We have discovered an unfortunate phenomenon that will hopefully lead us down a path of more personalized medicine," she says. "This helps us understand that surgery shouldn't be the same for men and women, and that we must educate ourselves about picking up symptoms in women sooner. Our take home is that we need to do more research." 

This paper is an initiative by the Canadian Thoracic Aortic Collaborative (CTAC) and uses nationwide data from almost 1,700 patients who have undergone aortic arch surgery. Data comes from cities across Canada including Victoria, Laval, Toronto – including the Peter Munk Cardiac Centre – Ottawa, Sudbury, Kingston and Winnipeg. A total of 10 institutions were involved in compiling this data. The CTAC, led by Dr. Chu, is a group of Canadian cardiac surgeons with interests in aortic surgery and work to promote it through a focus on clinical excellence, collaboration and research. 

"There shouldn't be an outcome gap between men and women," says Dr. Chung. "We shouldn't accept that women are more "fragile." We should work to minimize that gap as much as possible."

About Lawson Health Research Institute

As the research institute of London Health Sciences Centre and St. Joseph's Health Care London, and working in partnership with Western University, Lawson Health Research Institute is committed to furthering scientific knowledge to advance health care around the world. www.lawsonresearch.ca

About the Peter Munk Cardiac Centre

The Peter Munk Cardiac Centre (PMCC), established through the generous support of the Peter and Melanie Munk Charitable Foundation, is the premier cardiac centre in Canada. Since its opening, the PMCC has saved and improved the lives of cardiac and vascular patients from around the world. More than 163,000 patients annually receive innovative and compassionate care from multidisciplinary teams in the PMCC, which trains more cardiologists, cardiovascular surgeons, and vascular surgeons than any other hospital in Canada. The PMCC is based at the Toronto General Hospital, Toronto Western Hospital and Toronto Rehabilitation Institute – all members of University Health Network. For more information, visit www.petermunkcardiaccentre.ca

About University Health Network

University Health Network includes Toronto General and Toronto Western Hospitals, Princess Margaret Cancer Centre, Toronto Rehabilitation Institute and the Michener Institute for Education at UHN. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto. www.uhn.ca

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