Results of coronary artery bypass grafting without pump in females

Ricardo Guzmán-González; Guillermo Careaga-Reyna; Hugo Cardoza-Pacheco; Rubén Argüero-Sánchez

2008, Number 1

<< Back Next >>

Cir Cir 2008; 76 (1)

Results of coronary artery bypass grafting without pump in females

Guzmán-González R, Careaga-Reyna G, Cardoza-Pacheco H, Argüero-Sánchez R

Full text

How to cite this article

Language: Spanish
References: 21
Page: 29-36
PDF size: 67.55 Kb.

ABSTRACT

Background: Women have more risk factors for coronary bypass graft surgery such as diabetes, high blood pressure, obesity, heart failure and shorter height (less body surface), compared with men. However, off-pump coronary artery bypass grafting demonstrates more benefits in females because it has lower mortality, fewer postoperative respiratory complications, shorter hospital stay and improved outcome index.
Methods: We designed a retrospective study from the clinical files of females who underwent off-pump coronary artery bypass graft surgery in our hospital.
Results: Significant differences were found between genders in mean age, body surface area, incidence of high blood, unstable angina, left main coronary artery disease or its equivalent, urgent and emergency surgery, in relation to preoperative variables. According to the operative variables, we observed significant differences only in incomplete coronary artery bypass grafting. Postoperatively, differences were found in the use of inotropic support, late extubation (› 24 h), wound infections and postoperative death. Those differences were evident in the incidence of major and minor adverse outcomes, resulting in major morbidity and mortality in women (p = 0.049).
Conclusions: Higher morbidity and mortality is shown in women than in men after analyzing major and minor adverse outcomes that were more frequent in women.

REFERENCES

1. Jacobs AK. Women, ischemic heart disease, revascularization, and gender gap. What are we missing? J Am Coll Cardiol 2006;47:63S-65S.
2. Edwards FH, Carey JS, Grover FL, et al. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg 1998;66:125-131.
3. Davis KB, Chaitman B, Ryan T, Bittner V, Kennedy JW. Comparison of 15 year survival for men and women after initial medical or surgical treatment for coronary artery disease: a CASS registry study. J Am Coll Cardiol 1995;25:1000-1009.
4. Reis SE, Holubkov R, Smith AJC, et al. Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study. Am Heart J 2001;141:735-741.
5. Jacobs AK. Coronary revascularization in women in 2003: sex revisited. Circulation 2003;107:375-377.
6. Celermajer DS, Sorasen KE, Spiegelhalter DJ, Georgakopoulos D, Robison J, Deanfield JE. Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol 1994;24:471-476.
7. Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg 2003;125:1438-1450.
8. Wechsler A. The gender initiative. J Thorac Cardiovasc Surg 2003;126:617.
9. Nussmeier N. The female perspective: gender in cardiothoracic surgery. J Thorac Cardiovasc Surg 2003;126:618-619.
10. Oparil S. Improving outcomes for women after coronary artery bypass grafting: a case for prevention. J Thorac Cardiovasc Surg 2003;126:1704-1706.
11. Guru V, Fremes SE, Tu JV. Time-related mortality for women after coronary artery bypass graft surgery: a population-based study. J Thorac Cardiovasc Surg 2004;127:1158-1165.
12. Koch CG, Khandwala F, Nussmeier N, Blackstone EH. Gender and outcomes after coronary artery bypass grafting: a propensity-matched comparison. J Thorac Cardiovasc Surg 2003;126:2032-2043.
13. Mickleborough LL, Carson S, Ivanov J. Gender differences in quality of distal vessels: effect on results of coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;126:950-958.
14. Athanasiou T, Al-Ruzzeh S, Del Stanbridge, Casula RP, et al. Is the gender an independent predictor of adverse outcome after off-pump coronary artery bypass grafting? Ann Thorac Surg 2003;75:1153-1160.
15. Bucerios J, Gummert JF, Walther T, et al. Impact of off-pump coronary bypass grafting on the prevalence of adverse perioperative outcome in women undergoing coronary artery bypass grafting surgery. Ann Thorac Surg 2005;79:807-813.
Habib R, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Worse early outcomes in women after coronary artery bypass grafting: is it simply a matter of size? J Thorac Cardiovasc Surg 2004;128:487.
17. Brown P, Mack M. Outcomes experience with off-pump coronary artery bypass surgery in women. Ann Thorac Surg 2002;74:2113-2120.
18. Petro K, Dullum M. Minimally invasive coronary revascularization in women: a safe approach for a high-risk group. Heart Surg Forum 2000;3:41.
19. Mack M. On-pump versus off-pump coronary artery bypass surgery in a matched sample of women: a comparison of outcomes. Circulation 2004;110(suppl II):1-6.
20. Careaga G, Téllez S, Ramírez A, Argüero R. Revascularización miocárdica sin derivación cardiopulmonar. Informe de 160 casos. Cir Cir 2002;70:317-321.
21. Birkmeyer NJ, Charlesworth DC, Hernandez F, et al. Obesity and risk of adverse outcomes associated with coronary artery bypass surgery: Northern New England Cardiovascular Disease Group. Circulation 1998;97:1689-1694.