Impact of Gender on Outcome in Octogenarians after Coronary Artery Bypass Grafting

Abstract

Background Increasing life expectancy makes cardiac surgery in octogenarians not very uncommon. In this study, the impact of gender on outcome of octogenarians after coronary artery bypass grafting (CABG) was assessed.

Materials and Methods We retrospectively studied 485 octogenarians (176 females: mean age 82.4 ± 2.2 years vs. 306 males: mean age 82.2 ± 2.4 years) who underwent isolated CABG using extracorporeal circulation between January 2005 and December 2012.

Results No significant differences were noted between both gender groups with regard to preoperative risk factors. At baseline, the groups differed significantly with respect to mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) (women: 22.3 ± 17.4% vs. men: 17.5 ± 13.3%; p < 0.001). Likewise, EuroSCORE II differs significantly between women and men in our cohort (women: 16.7 ± 11.9% vs. men: 13.9 ± 10.7%; p = 0.008). Intraoperatively, the number of distal anastomoses (3.1 ± 0.9 vs. 3.2 ± 0.8), the mean extracorporeal circulation time (99 ± 31 vs. 102 ± 29 minutes), and the mean aortic cross-clamp time (63 ± 31 vs. 60 ± 19 minutes) were similar in both groups. Postoperatively, no significant differences in complications and major morbidity were observed between the groups. The 30-day mortality (women 8.0 vs. men 9.7%; p = 0.62) were without statistical significance between the groups.

Conclusion Outcome of octogenarians after CABG resulted in acceptable mortality. Female gender was not associated with increased risks for morbidity and mortality after surgery. Satisfactory outcomes encourage the offering of surgery in octogenarians.

Keywords

cardiopulmonary bypass - CPB - elderly - coronary artery bypass grafting - CABG

• References

• 1 Malenka DJ, Leavitt BJ, Hearne MJ , et al; Northern New England Cardiovascular Disease Study Group. Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England. Circulation 2005; 112 (9, Suppl): I371-I376
• 2 Park DW, Kim YH, Song HG , et al. Long-term comparison of drug-eluting stents and coronary artery bypass grafting for multivessel coronary revascularization: 5-year outcomes from the Asan Medical Center-Multivessel Revascularization Registry. J Am Coll Cardiol 2011; 57 (2) 128-137
• 3 Leening MJ, Ferket BS, Steyerberg EW , et al. Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study. BMJ 2014; 349 (17) g5992
• 4 Mack M, Gopal A. Epidemiology, traditional and novel risk factors in coronary artery disease. Heart Fail Clin 2016; 12 (1) 1-10
• 5 Blankstein R, Ward RP, Arnsdorf M, Jones B, Lou YB, Pine M. Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 Midwestern hospitals. Circulation 2005; 112 (9, Suppl): I323-I327
• 6 Toumpoulis IK, Anagnostopoulos CE, Balaram SK , et al. Assessment of independent predictors for long-term mortality between women and men after coronary artery bypass grafting: are women different from men?. J Thorac Cardiovasc Surg 2006; 131 (2) 343-351
• 7 Edwards FH, Ferraris VA, Shahian DM , et al; Society of Thoracic Surgeons. Gender-specific practice guidelines for coronary artery bypass surgery: perioperative management. Ann Thorac Surg 2005; 79 (6) 2189-2194
• 8 Guru V, Fremes SE, Austin PC, Blackstone EH, Tu JV. Gender differences in outcomes after hospital discharge from coronary artery bypass grafting. Circulation 2006; 113 (4) 507-516
• 9 Jussli-Melchers J, Berndt R, Haneya A, Heller C, Schoeneich F, Cremer J. Impact of gender on outcome in octogenarians after coronary artery bypass grafting. Thorac Cardiovasc Surg 2015; 63: ePP26
• 10 Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RS. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg 1998; 66 (1) 125-131
• 11 Poullis M, Pullan M, Chalmers J, Mediratta N. The validity of the original EuroSCORE and EuroSCORE II in patients over the age of seventy. Interact Cardiovasc Thorac Surg 2015; 20 (2) 172-177
• 12 Lehmkuhl E, Kendel F, Gelbrich G , et al. Gender-specific predictors of early mortality after coronary artery bypass graft surgery. Clin Res Cardiol 2012; 101 (9) 745-751
• 13 Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause 2006; 13 (2) 265-279
• 14 Abramov D, Tamariz MG, Sever JY , et al. The influence of gender on the outcome of coronary artery bypass surgery. Ann Thorac Surg 2000; 70 (3) 800-805 , discussion 806
• 15 Kim C, Redberg RF, Pavlic T, Eagle KA. A systematic review of gender differences in mortality after coronary artery bypass graft surgery and percutaneous coronary interventions. Clin Cardiol 2007; 30 (10) 491-495
• 16 Kurlansky PA, Traad EA, Dorman MJ, Galbut DL, Zucker M, Ebra G. Bilateral internal mammary artery grafting reverses the negative influence of gender on outcomes of coronary artery bypass grafting surgery. Eur J Cardiothorac Surg 2013; 44 (1) 54-63
• 17 Glaser R, Herrmann HC, Murphy SA , et al. Benefit of an early invasive management strategy in women with acute coronary syndromes. JAMA 2002; 288 (24) 3124-3129