Gender Differences in Patients Undergoing Cardiac Surgery

Objectives: Coronary syndrome or coronary artery disease (CAD). No clear evidence is given if gender is an independent risk factor for patients undergoing surgical treatment for CAD. We herein report our experience with patients undergoing surgical coronary artery bypass grafting (CABG) as an isolated or combined procedure and furthermore evaluated gender-differences in 30-day outcomes.

Methods: From 12/2012 to 01/2018, a total of 2,693 consecutive patients underwent CABG (isolated or as combined procedure) at our institution. Pre- and perioperative data and 30-day outcomes between women (group female (f); n = 552, 20.5%) and men (group male (m); n = 2141, 79.5%) were retrospectively analyzed.

Result: Perioperative data presented differences regarding age (group f: 70.2 ± 16.0 vs. group m: 66.8 ± 9.3 years; p < 0.001), concomitant severe mitral regurgitation (11.9 vs. 5.2%; p < 0.001) and rates of concomitant valve procedures (37.1 vs. 25.2%; p < 0.01). Risk scores were higher in group f (STS PROM Score 1.6 vs. 0.8%; p < 0.001, EuroSCORE II 3.9 vs. 2.5%; p < 0.01). Outcomes for isolated CABG regarding 30-day mortality were similar for group f and m (2.1 vs. 1.2%; p = 0.35) but rates for MI (0.3 vs. 3.3%; p < 0.0001) and postoperative stroke (1.1 vs. 4.8%; p = 0.0002) were significantly higher in group f. Overall 30-day mortality for combined procedures was higher in group f (5.7 vs. 4.8%; p = 0.025) as well as postoperative rates of MI (2.4 vs. 0.8%; p = 0.004). No differences were seen in rates of major stroke (2.2 vs. 1.9%; p = 0.73). Logistic regression analysis revealed that female gender was not an independent risk factor for 30-day mortality (p = 0.46). Independent risk factors for 30-day mortality were preoperative NYHA functional class IV for group f and age, emergency cases, endocarditis, renal dialysis and atrial fibrillation for group m.

Conclusion: Isolated CABG procedures showed inferior results for female patients in concerns of postoperative stroke and MI. For combined procedures, female patients showed a higher 30-day mortality and incidence of postoperative MI. Female gender was not identified as an independent risk factor in the overall patient cohort. However, female patients presented with a higher risk profile and higher rates of severe heart valve diseases, clinically reflected by a higher NYHA functional class. Larger studies are needed to identify risk factors and provide equal treatment quality for each patient.

Publikationsverlauf

Artikel online veröffentlicht:
19. Februar 2021