Female Risk Using OPCAB, ?-Circuit, and Aorta No-Touch Coronary Revascularization
DOI:
https://doi.org/10.1532/HSF98.20091124Abstract
Background: In this study, we evaluated female sex as a risk factor in the off-pump coronary artery bypass (OPCAB), aorta no-touch technique.
Materials and Methods: From February 2001 to November 2005, 1359 patients in our institution underwent isolated coronary revascularization with the ?-circuit technique, which consists of (1) beating heart surgery, (2) OPCAB, (3) no touching of the aorta, (4) use of composite grafts, and (5) arterial revascularization. There were 1159 men (group A) and 200 women (group B). Both groups were compared with respect to preoperative risk factors, intraoperative parameters, and postoperative morbidity and mortality. Follow-up lasted from 4 to 60 months. Data were analyzed with the ?2 test, the Fisher exact test, the Kaplan-Meier method, and the Cox model of regression analysis.
Results: Female patients were older (P < .0005) and had higher prevalences of obesity (P < .0005), arterial hypertension (P < .0005), and diabetes (P < .0005). Emergency operations were also more frequent in this group (P < .027). There was no difference between the groups in the preoperative use of an intra-aortic balloon pump (IABP). The 2 groups were not significantly different with respect to 30-day mortality (1.1% versus 4%) or 7-day mortality (0.3% versus 0%). The 2 groups had comparable rates of IABP use postoperatively. Cognitive disturbances and strokes were rarely encountered (0.6% in men and 0.2% in women). In the early postoperative phase, women had more pulmonary complications (P < .014), and survival seemed to favor the male group during the follow-up period (P < .001). Further analysis with the Cox regression model with exclusion of confounding preoperative morbidity factors (more prevalent in group B) showed that the 2 groups had similar survival rates. As a group, women were 1.06 times more likely to die from a cardiac cause than men (P < .897).
Conclusions: The use of the ?-circuit, aorta no-touch technique is equally effective and safe for both sexes. Women are more prone to pulmonary complications in the early postoperative phase. The apparent difference in survival favoring men can be attributed to the higher prevalence of preoperative risk factors in women. In general, we consider the off-pump, aorta no-touch technique an effective method for lowering morbidity and mortality in the relatively high-risk female patient group.
References
Abramov D, Tamariz MG, Sever JY, et al. 2000. The influence of gender on the outcome of coronary artery bypass surgery. Ann Thorac Surg 70:800-6.nAldea GS, Gaudiani JM, Shapira OM, et al. 1999. Effect of gender on postoperative outcomes and hospital stays after coronary artery bypass grafting. Ann Thorac Surg 67:1097-103.nAmerican Heart Association. 2005. Heart Disease and Stroke Statistics—2005 Update. Dallas, TX: American Heart Association. Available at: http://www.americanheart.org/downloadable/heart/1105390918119HDSStats2005Update.pdf'>http://www.americanheart.org/downloadable/heart/1105390918119HDSStats2005Update.pdfnAthanasiou T, Al-Ruzzeh S, Del Stanbridge R, Casula RB, Glenville BE, Amrani M. 2003. Is the female gender an independent predictor of adverse outcome after off-pump coronary artery bypass grafting? Ann Thorac Surg 75:1153-60.nBrown PP, Mack MJ, Simon AW, et al. 2002. Outcomes experience with off-pump coronary artery bypass surgery in women. Ann Thorac Surg 74:2113-9.nBucerius J, Gummert JF, Walther T, et al. 2005. 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 79:807-13.nEdwards FH, Carey JS, Grover FL, Bero JW, Hartz RS. 1998. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg 66:125-31.nEdwards FH, Ferraris VA, Shahian DM, et al. 2005. Gender-specific practice guidelines for coronary bypass surgery: perioperative management. Ann Thorac Surg 79:2189-94.nFisher LD, Kennedy JW, Davis KB. 1982. Association of sex, physical size and operative mortality after coronary bypass in the Coronary Artery Surgery Study (CASS). J Thorac Cardiovasc Surg 84:334-41.nJacobs AK, Kelsey SF, Brooks MM, et al. 1998. Better outcome for women compared with men undergoing coronary revascularization: a report from the Bypass Angioplasty Revascularization Investigation (BARI). Circulation 98:1279-85.nJones RH, Hannan EL, Hammermeister KE, et al. 1996. Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. Working Group Panel on the Cooperative CABG Database Project. J Am Coll Cardiol 28:1478-87.nKennedy JW, Kaiser GC, Fisher LD, et al. 1980. Multivariate discriminant and angiographic predictors operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS). J Thorac Cardiovasc Surg 80:876-87.nMack M, Bachand D, Acuff T, et al. 2002. Improved outcomes in coronary artery bypass grafting with beating-heart techniques. J Thorac Cardiovasc Surg 124:598-607.nMerz CN, Kelsey SF, Pepine CJ, et al. 1999. The Women's Ischemia Syndrome Evaluation (WISE) study: protocol design, methodology and feasibility report. J Am Coll Cardiol 33:1453-61.nO'Connor GT, Morton JR, Deihl MJ. 1993. Differences between men and women in hospital mortality associated with coronary bypass artery graft surgery. The Northern New England Cardiovascular Disease Study Group. Circulation 88(pt 1):2104-10.nO'Rourke DJ, Malenka DJ, Olmstead EM, et al. 2001. Improved in-hospital mortality in women undergoing coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg 71:507-11.nPrapas SN, Anagnostopoulos CE, Kotsis V, et al. 2002. A new pattern for using both thoracic arteries to revascularize the entire heart: the ?-graft. Ann Thorac Surg 73:1990-2.nShin AY, Jaglal S, Slaughter P, Iron K. 1999. Women and heart disease. In: Naylor CD, Slaughter PM, eds. Cardiovascular health & services in Ontario: an ICES atlas. Toronto, Canada: Institute for Clinical Evaluative Sciences. p 335-53.nTu JV, Jaglal SB, Naylor DC,. and the Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. 1995. Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Circulation 91:677-84.n
