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[Coronary surgery in females]
K F Lindenau1, D Olthoff, H Adam
1Herzzentrum der Karl-Marx-Universität Leipzig.
Insights
Women undergoing surgery for ischemic heart disease face higher risks and poorer graft outcomes compared to men. Despite initial higher mortality, long-term survival rates are similar for both sexes.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Medical Statistics
Context:
- Ischemic heart disease (IHD) affects numerous patients requiring surgical intervention.
- Recent data indicates a lower proportion of women (8.6%) undergoing IHD surgery.
- Pre-menopausal women are rarely candidates for IHD surgery.
Purpose:
- To compare surgical outcomes for ischemic heart disease between men and women.
- To identify risk factors and technical challenges in female patients undergoing IHD surgery.
Summary:
- Women undergoing IHD surgery presented with more risk factors, including hypertension and hypercholesterolemia.
- Hospital mortality for isolated revascularization was higher in women (4.9%) than men (1.5%).
- Women had fewer grafts per patient, lower rates of complete revascularization, and reduced graft patency (66% vs. 84% at one year).
Impact:
- Despite initial disparities, one-year survival rates were comparable between sexes (94.4% for women, 95% for men).
- Marked coronary sclerosis and unique arterial morphology in women present surgical challenges.
- Technical skill is crucial for successful surgical outcomes in female IHD patients.
Abstract:
In the last three years, of a total of 617 patients undergoing surgery for ischemic heart disease, 53 were women (8.6%). With one exception, all were in or shortly before the menopause. As compared with men, the women were found to have a preponderance of risk factors. The most unfavorable combination, that of hypertension and hypercholesterolemia, was present in one-third of the patients. Hospital mortality for isolated revascularization was higher in women at 4.9% than in men at 1.5%. The one-year survival rates, however, of 94.4% and 95%, respectively, did not differ between the two sexes. In women, the number of grafts per patient was 2.1 as compared with 2.9 in men. Complete revascularization was achieved less frequently in women than in men; similarly graft patency rate at one year of 66% in women was less than the 84% observed in men. The more marked coronary sclerosis as well as morphologic characteristics of coronary arteries in women construe a special challenge to the surgeon and prerequisite a high degree of technical skill.