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Updated: Nov 5, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Review of the differences in outcomes between males and females after revascularization
Ryaan El-Andari1, Sabin J Bozso2, Jimmy J H Kang1
1Faculty of Medicine and Dentistry.
Insights
Female patients experienced higher morbidity and mortality after traditional coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Minimally invasive cardiac surgery showed comparable outcomes between sexes, highlighting potential benefits for women.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Disparities
Background:
- Previous studies indicate females have worse outcomes after coronary revascularization compared to males.
- Differences in outcomes between sexes narrow but persist even after adjusting for preoperative risks.
Purpose of the Study:
- To compare outcomes between males and females undergoing various coronary revascularization procedures.
- To evaluate the impact of minimally invasive approaches on sex-based outcome disparities.
Main Methods:
- Systematic review of studies comparing male and female outcomes after Coronary Artery Bypass Grafting (CABG), Percutaneous Coronary Intervention (PCI), Off-Pump CABG (OPCAB), Minimally Invasive Direct CABG (MIDCAB), and Robotic Total Endoscopic CABG (TECAB).
Main Results:
- Females showed higher rates of morbidity and mortality post-PCI and CABG.
- Risk adjustment reduced, but did not eliminate, these sex-based outcome differences.
- Outcomes were generally comparable between males and females undergoing OPCAB, MIDCAB, and TECAB.
Conclusions:
- Minimally invasive cardiac surgery offers comparable outcomes for both sexes and may reduce disparities.
- Optimizing diagnosis and referral for females, who often have higher comorbidities, is crucial.
- Further research into sex-specific approaches in coronary revascularization is warranted.
Purpose Of Review:
This review aims to compare outcomes of males and females undergoing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), off-pump CABG (OPCAB), minimally invasive direct CABG (MIDCAB), and robotic total endoscopic CABG (TECAB).
Recent Findings:
Females demonstrated increased rates of morbidity and mortality post PCI and CABG. In studies that performed risk adjustments, these differences were reduced. Although inferior outcomes were observed for females in some measures, generally outcomes between males and females were comparable post OPCAB, MIDCAB, and TECAB.
Summary:
Previous literature has demonstrated that females undergoing coronary revascularization experience inferior postoperative outcomes when compared to their male counterparts. The discrepancies between males and females narrow, but do not disappear when preoperative risks are accounted for and when considering minimally invasive approaches such as MIDCAB, OPCAB, and TECAB. Minimally invasive cardiac surgery has demonstrated numerous benefits with reduced morbidity, mortality, and shorter recovery times. In patients with increased comorbidities, minimally invasive approaches confer a greater advantage. As females often fall within this category, it is paramount that the diagnosis and referral process be optimized to account for preoperative differences to provide the most beneficial approach if the disparity between the sexes is to be addressed.
