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Published on: March 27, 2018
Early results of coronary artery bypass graft surgery in women
Bronisław Czech1, Ewa Kucewicz-Czech, Jerzy Pacholewicz
1Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia, ul. Szpitalna 2, 41-800 Zabrze, Poland.
Insights
Women undergoing coronary artery bypass grafting (CABG) experience higher rates of mortality and complications compared to men. This study highlights increased perioperative risks for female patients receiving CABG surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Coronary artery disease (CAD) is a leading cause of death in women globally.
- Coronary artery bypass grafting (CABG) is a standard treatment for severe CAD.
- Differences in CABG outcomes between sexes warrant investigation.
Purpose of the Study:
- To retrospectively compare early outcomes of CABG in women versus men.
- To identify specific risk factors and complications in female CABG patients.
Main Methods:
- Analysis of 2881 patients (677 women, 2204 men) who underwent CABG between 2003-2005.
- Comparison of operative techniques (on-pump vs. off-pump) and patient demographics.
- Assessment of perioperative complications, reoperations, and mortality.
Main Results:
- Women were older, had higher BMI, and more comorbidities (diabetes, hypertension, hypercholesterolemia).
- Higher rates of left ventricular failure, perioperative myocardial infarction, repeat operations, and blood transfusions in women.
- Increased incidence of acute renal failure, longer mechanical ventilation, and longer hospital stays in female patients.
- Early postoperative mortality was significantly higher in women (3.6%) compared to men (1.6%).
Conclusions:
- Mortality and morbidity following CABG are significantly higher in women than in men.
- Female patients face increased perioperative risks and adverse outcomes after CABG.
- Further research into sex-specific management strategies for CABG is recommended.
Background:
Coronary artery disease is one of the leading causes of death among women in developed countries all over the world. Coronary artery bypass grafting (CABG) is a well established therapeutic modality to treat diffuse coronary artery atherosclerosis.
Aim:
In this study we focused on the retrospective assessment of the early results of CABG in women as compared to the results of such treatment in men.
Methods:
This analysis involved 2881 patients (677 women and 2204 men) who underwent CABG between 2003 and 2005. An operative technique (conventional on-pump or off-pump) was applied in a similar proportion of patients in both groups (on-pump: 59.4% of women and 59.6% of men; NS). Women were older than men and had higher body mass index. Concomitant disorders such as diabetes mellitus, hypertension and hypercholesterolaemia were noted more frequently in female patients.
Results:
In the perioperative period, left ventricular failure requiring intra-aortic balloon pump insertion and administration of high doses of catecholamines was observed significantly more often in women than in men (22.1 vs. 16.1%, respectively; p <0.001). Perioperative myocardial infarction was diagnosed more frequently in women (5.5 vs. 2.9%; p <0.001). In female patients, the rate of repeat operation was higher (8.9 versus 5.1%; p <0.001) and more subjects required blood transfusions (45.5 vs. 27.5%; p <0.001). Female gender featured a higher rate of postoperative acute renal failure requiring renal replacement therapy (8.5 vs. 0.95%; p <0.001). Mechanical ventilation was longer, and women stayed longer in the postoperative intensive care unit as well as in hospital. Early postoperative mortality among women was 3.6%, i.e. significantly higher than in male patients (1.6%) (p <0.01).
Conclusions:
The analysis performed herein suggests that mortality and morbidity after CABG is higher in women than in men.
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