Early Postoperative Results of On-Pump Coronary Endarterectomy: Is Gender a Risk Factor?
Gender effect on coronary endarterectomy
DOI:
https://doi.org/10.1532/hsf.3929Keywords:
Coronary endarterectomy, females, males, gender difference, on-pump coronary artery bypass graftAbstract
Background: Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) is an effective but still controversial surgical strategy for the treatment of diffuse coronary artery disease. In this study, we aimed to investigate the impact of gender differences on operative and early postoperative results of patients who underwent CABG with CE.
Methods: This retrospective study included 141 patients who had undergone CE combined with CABG from January 2015 to December 2020, as well as 141 patients without CE as the control group. First, patients with and without CE were compared. Next, patients undergoing CE were divided into 2 groups according to gender (group 1, male patients; group 2, female patients).
Results: Of the 141 patients who underwent CE combined with on-pump CABG, 95 (67.3%) were male, and median age was 66 years (range 58 to 71.2). Of the 141 patients who underwent isolated on-pump CABG, 99 (70.2%) were males, and median age was 63 years (range 41 to 80.4). The data for these 2 groups (with and without CE) were compared. Previous percutaneous coronary intervention (PCI), presence of diabetes mellitus, and perfusion time were significantly more common in the CE group. There were 95 patients in group 1, with a median age of 65 years (range 58 to 69), and 46 patients in group 2, with a median age of 66 (64 to 71.2). There were no difference between the groups in terms of age, body mass index, hyperlipidemia, chronic obstructive pulmonary disease, peripheral artery disease, or previous coronary intervention. The need for positive inotropic support and postoperative atrial fibrillation were found to be significantly more common in group 2 (P = .022 and .039, respectively). Defibrillation after releasing the aortic cross clamp was also significantly more common in group 2 (P = .025).
Conclusion: In our study, the need for defibrillation after aortic cross-clamp releasing in the perioperative period, the need for inotropic support and the incidence of atrial fibrillation in the post-operative period, increased significantly in the female gender. CE can be performed safely in both genders with acceptable mortality and morbidity rates.
References
Abramov D, Tamariz MG, Sever JY, et al. The influence of gender on the outcome of coronary artery bypass surgery. Ann Thorac Surg 2000;70:800-805.
Alam M, Bandeali SJ, Kayani WT, et al. Comparison by meta analysis of mortality after isolated coronary artery bypass grafting in women versus men. Am J Cardiol 2013;112:309-317.
Aldea GS, Gaudiani JM, Shapira OM, et al. Effect of gender on postoperative outcomes and hospital stays after coronary artery bypass grafting. Ann Thorac Surg 1999;67:1097-1103.
Amato VL, Timerman A, Paes AT, et al. Immediate results of myocardial revascularization. Comparison between men and women [in Portuguese]. Arq Bras Cardiol 2004.;3(Spec No):14-20.
Cameron A, Davis KB, Green G, Schaff HV. Coronary bypass surgery with internal-thoracic-artery grafts—effects on survival over a 15-year period. N Engl J Med 1996;334:216-219.
Costa MACD, Betero AL, Okamoto J, et al. Coronary endarterectomy: a case control study and evaluation of early patency rate of endarterectomized arteries. Braz J Cardiovasc Surg 2020;35:9-15.
Eris C, Erdolu B, Engin M, et al. The effects of aortic clamping strategy on myocardial protection and early postoperative outcomes during coronary artery bypass grafting operations. Heart Surg Forum 2021;24:E217-E222.
Ghatanatti R, Teli A. Coronary endarterectomy: recent trends. J Clin Diagn Res 2017;11:PE01-PE04.
Göksedef D, Ömeroğlu SN, Balkanay OO, et al. Coronary artery bypass in women: what is really different? Turk Gogus Kalp Dama 2012;20:8-13.
Güvenç O, Göncü MT, Engin M, et al. Effects of coronary endarterectomy on postoperative early results in long segment coronary artery disease. Eur Res J 2020;6:187-192.
Kim C, Redberg RF, Pavlic T, Eagle KA. A systematic review of gender differences in mortality after coronary artery bypass graft surgery and percutaneous coronary interventions. Clin Cardiol 2007;30:491-495.
Livesay JJ, Cooley DA, Hallman GL, et al. Early and late results of coronary endarterectomy: analysis of 3,369 patients. J Thorac Cardiovasc Surg 1986;92:649-660.
Russo M, Nardi P, Saitto G, et al. Single versus double antiplatelet therapy in patients undergoing coronary artery bypass grafting with coronary endarterectomy: mid-term results and clinical implications. Interact Cardiovasc Thorac Surg 2017;24:203-208.
Santini F, Casali G, Lusini M, et al. Mid-term results after extensive vein patch reconstruction and internal mammary grafting of the diffusely diseased left anterior descending coronary artery. Eur J Cardiothorac Surg 2002;21:1020-1025.
Ranucci M, Pazzaglia A, Bianchini C, et al. Body size, gender, and transfusions as determinants of outcome after coronary operations. Ann Thorac Surg 2008;85:481-486.
Sabzi F, Asadmobini A. Gender difference in long- and short-term outcomes of off-pump coronary endarterectomy. Ann Card Anaesth 2020;23:419-424.
Sannino A, Szerlip M, Harrington K, et al. Comparison of baseline characteristics and outcomes in men versus women with aortic stenosis undergoing transcatheter aortic valve implantation. Am J Cardiol 2018;121:844-849.
Sheifer SE, Canos MR, Weinfurt KP, et al. Sex differences in coronary artery size assessed by intravascular ultrasound. Am Heart J 2000;139:649-653.
Stavrou A, Gkiousias V, Kyprianou K, et al. Coronary endarterectomy: the current state of knowledge. Atherosclerosis 2016;249:88-98.
Takahashi M, Gohil S, Tong B, et al. Early and mid-term results of off-pump endarterectomy of the left anterior descending artery. Interact Cardiovasc Thorac Surg 2013;16:301-305.
Tiruvoipati R, Loubani M, Lencioni M, et al. Coronary endarterectomy: impact on morbidity and mortality when combined with coronary artery bypass surgery. Ann Thorac Surg 2005;79:1999-2003.
Tiruvoipati R, Loubani M, Peek G. Coronary endarterectomy in the current era. Curr Opin Cardiol 2005;20:517-520.
Toumpoulis IK, Anagnostopoulos CE, Balaram SK, et al. Assessment of independent predictors for long-term mortality between women and men after coronary artery bypass grafting: are women different from men? J Thorac Cardiovasc Surg 2006;131:343-351.
Trabattoni D, Teruzzi G, Montorsi P, et al. Comparison of the effectiveness of percutaneous intervention of the left-main coronary artery with everolimus-eluting stents in women -vs- men. Am J Cardiol 2019;124:1357-1362.
Walli-Attaei M, Joseph P, Rosengren A, et al. Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020;396:97-109.
Yüksel A, Kan II, Yolgösteren A, et al. Are the early postoperative outcomes of coronary artery bypass grafting surgery in elderly women worse compared to men’s? Braz J Cardiovasc Surg 2017;32:191-196.
