Doenst Torsten, Ivanov Joan, Borger Michael A, David Tirone E, Brister Stephanie J
Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Ontario, Canada.
Ann Thorac Surg. 2006 May;81(5):1632-6. doi: 10.1016/j.athoracsur.2005.11.052.
The purpose of this study is to compare sex-specific, long-term outcomes after combined valve and coronary artery bypass graft surgery (CABG).
Between 1990 and 2000, 1,567 patients underwent combined valve and CABG surgery at our institution. Our surgical database was linked to a governmental administrative hospital discharge database and a registry of deaths to obtain long-term follow-up. All patients underwent CABG plus aortic (62%), mitral (31%), or multiple valve surgery (7%).
Women had more preoperative risk factors than men (namely, hypertension, diabetes mellitus, congestive heart failure, atrial fibrillation, and stroke; all p < 0.001). The prevalence of triple-vessel disease was the same between men and women, but women received fewer mammary grafts and fewer total bypass grafts (both p < 0.01). Women received fewer mitral valve repairs and more mitral valve replacements than men (p = 0.014). Length of follow-up was 5.3 +/- 3.2 years (mean +/- SD; range, 0 to 12.5) and was 99.8% complete. Both sexes had similar long-term survival rates. Women were at higher risk of stroke during follow-up (risk ratio = 1.52, 95% confidence interval: 1.1 to 2.1). There were no sex differences in rehospitalization for acute myocardial infarction (p = 0.9), heart failure (p = 0.4), redo cardiac surgery (p = 0.5), or endocarditis (p = 0.4).
Women have a higher preoperative risk profile than men undergoing combined valve and CABG surgery, but long-term survival rates are similar. Female sex is an independent predictor of stroke during follow-up. Further studies should focus on the cause of increased risk of stroke and methods of prevention.
本研究的目的是比较瓣膜置换与冠状动脉旁路移植术（CABG）联合手术后的性别特异性长期预后。
1990年至2000年间，我院1567例患者接受了瓣膜置换与CABG联合手术。我们的手术数据库与政府行政医院出院数据库及死亡登记处相链接，以获得长期随访数据。所有患者均接受了CABG加主动脉瓣手术（62%）、二尖瓣手术（31%）或多瓣膜手术（7%）。
女性术前危险因素比男性多（即高血压、糖尿病、充血性心力衰竭、心房颤动和中风；均p<0.001）。男性和女性三支血管病变的患病率相同，但女性接受的乳腺移植物和总旁路移植物较少（均p<0.01）。女性接受二尖瓣修复术比男性少，二尖瓣置换术比男性多（p=0.014）。随访时间为5.3±3.2年（平均±标准差；范围0至12.5年），随访完成率为99.8%。两性的长期生存率相似。女性在随访期间中风风险较高（风险比=1.52，95%置信区间：1.1至2.1）。急性心肌梗死再住院率（p=0.9）、心力衰竭（p=0.4）、再次心脏手术（p=0.5）或心内膜炎（p=0.4）无性别差异。
接受瓣膜置换与CABG联合手术的女性术前风险状况高于男性，但长期生存率相似。女性是随访期间中风的独立预测因素。进一步研究应关注中风风险增加的原因及预防方法。
