Gender-specific Outcome after Off-Pump Coronary Artery Bypass Grafting: A Single-center Retrospective Analysis

Background: Several studies have shown the importance of gender-specific therapies of coronary artery disease (CAD), as outcomes after bypass surgery may differ between sexes. This retrospective single-center analysis aims to identify differences in outcome after Off-Pump Coronary Artery Bypass Grafting (OPCAB) between female and male patients.

Methods: A retrospective analysis was conducted in 2,311 patients who received an isolated OPCAB procedure at our center between 2009 and 2022. These patients were divided into male (n = 1,841) and female (n = 470) patients. Baseline characteristics, comorbidities, and periprocedural variables were collected for analysis.

Results: Male patients were significantly younger (68.5(±9.7) versus 70.3(±9.9); p < 0.001) and with a lower number of patients older than 80 years (8.4% versus 11.7%; p = 0.03). Although the body mass index (BMI) was comparable between both groups, the female group contained a significantly higher number of patients with a BMI greater than 35 kg/m² (6.5% versus 10.6%), p = 0.004). While more female patients suffered from NYHA III or higher (59.5% versus 63.8%; p = 0.014) most comorbidities such as COPD, arterial hypertension, or insulin-dependent diabetes mellitus (IDDM) were comparable between the two groups. Female patients showed a lower GFR (71 mL/min (±20) versus 66 mL/min (±22); p < 0.001) but there was no difference in need of dialysis (1.9% vs. 2.2%; p = 0.711). Male patients were more likely to suffer from main stem stenosis greater than 50% (30.0% versus 22.1%; p < 0.001). Concerning periprocedural parameters we discovered a larger amount of post-sternotomy wound infection (PSWI, 2.0% versus 4.5%; p < 0.001) and deep sternal wound infection (0.6% versus 1.7%; p = 0.038) in female patients, despite the fact that the rate of BIMA use was lower in this group (54.9% versus 35.7%; p < 0.001). No significant differences in MACCEs (myocardial infarction, major stroke, acute kidney injury) were shown. The 30-day mortality was comparable between male and female patients (1.45% versus 1.5%; p = 0.83).

Conclusion: OPCAB is a safe and feasible treatment option for female patients regarding MACCEs when compared with their male counterparts. Since our analysis found no difference in 30-day mortality, although females are at higher risk for surgery, off-pump procedures may be preferred in this group. However, more randomized multi-center trials are necessary to substantiate these findings.

Publication History

Article published online:
11 February 2025