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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Cardiac and neurologic complications identify risks for mortality for both men and women undergoing coronary artery
C W Hogue1, T Sundt, B Barzilai
1Department of Anestesiology, Washigton University School of Medicine, St. Louis, Missouri 63110, USA. hoguec@notes.wustl.edu
Insights
Women undergoing coronary artery bypass graft surgery face higher mortality and complication rates. Key mortality factors like low cardiac output syndrome and stroke are similar for both sexes, despite women
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Outcomes Research
Background:
- Existing research indicates sex-based differences in response to coronary artery bypass graft (CABG) surgery.
- However, the specific variables predicting mortality in women after CABG remain incompletely understood.
- This study aimed to delineate factors independently associated with mortality in female CABG patients.
Purpose of the Study:
- To identify independent predictors of mortality for women undergoing coronary artery bypass graft surgery.
- To compare mortality variables between sexes undergoing CABG.
Main Methods:
- Prospective data from 5,113 patients (30.5% women) undergoing CABG were analyzed.
- Patient characteristics and operative outcomes were assessed based on sex.
- Complications included low cardiac output syndrome, stroke, myocardial infarction, atrial fibrillation, and operative mortality.
Main Results:
- Women were older and had higher rates of pre-existing hypertension, diabetes, and stroke history.
- Operative mortality was higher in women (3.5%) than men (2.5%).
- Women experienced higher rates of postoperative myocardial infarction, stroke, and low cardiac output syndrome; however, key mortality predictors were similar across sexes, with age not being an independent predictor for women.
Conclusions:
- Women exhibit higher perioperative mortality following CABG compared to men.
- Increased cardiac and neurological complications contribute significantly to women's higher operative mortality.
- Independent factors associated with perioperative mortality are largely consistent between men and women undergoing CABG.
Background:
Despite a number of studies showing that women and men respond to coronary artery bypass graft surgery differently, it is not known whether variables associated with mortality are the same for women and men. The purpose of this study was to identify variables independently associated with mortality for women undergoing coronary artery bypass graft surgery.
Methods:
Single-institutional data were prospectively collected from 5,113 patients (1,558 or 30.5% women) undergoing coronary artery bypass graft surgery. The database was reviewed for patient characteristics and operative outcomes based on sex. Complications evaluated included low cardiac output syndrome (cardiac index < 2.0 l x min(-1) x m(-2) for > 8 h, regardless of treatment), stroke (new permanent global or focal motor deficits), Q-wave myocardial infarction, postoperative atrial fibrillation, and operative mortality.
Results:
Women were older than men, and they were more likely to have preexisting hypertension, diabetes, and a history of stroke. Operative mortality for women was higher than for men (3.5% vs. 2.5%, P < 0.05). Compared with men, women were more likely to experience a postoperative myocardial infarction, stroke, and low cardiac output syndrome. When performing analysis on data from both sexes separately, low cardiac output syndrome, new stroke, myocardial infarction, and duration of cardiopulmonary bypass were independently associated with mortality for women and men both. Patient age was not independently associated with risk for mortality for women, but it was for men. However, when the authors combined both sexes in the logistic regression analysis, the age-sex interaction was not significant (P = 0.266), indicating that there was insufficient evidence to assert that age has a different effect on mortality for men and women.
Conclusions:
These data confirm that women have higher perioperative mortality after coronary artery bypass graft surgery compared with men. A higher frequency of cardiac and neurologic complications seem to account to a large extent for the higher operative mortality for women. Factors independently associated with perioperative mortality are generally similar for women and men.
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