Prapas Sotirios N, Panagiotopoulos Ioannis A, Ayyad Mohamed A Salama, Kotsis Vassilis N, Protogeros Dimitris A, Linardakis Ioannis N, Tzanavaras Theofanis P, Danou Fotini N
Department of Cardiac Surgery, Henry Dunant Hospital, Mesoghion 107, Athens GR 11521, Greece.
Heart Surg Forum. 2009 Dec;12(6):E344-8. doi: 10.1532/HSF98.20091124.
In this study, we evaluated female sex as a risk factor in the off-pump coronary artery bypass (OPCAB), aorta no-touch technique.
From February 2001 to November 2005, 1359 patients in our institution underwent isolated coronary revascularization with the pi-circuit technique, which consists of (1) beating heart surgery, (2) OPCAB, (3) no touching of the aorta, (4) use of composite grafts, and (5) arterial revascularization. There were 1159 men (group A) and 200 women (group B). Both groups were compared with respect to preoperative risk factors, intraoperative parameters, and postoperative morbidity and mortality. Follow-up lasted from 4 to 60 months. Data were analyzed with the chi(2) test, the Fisher exact test, the Kaplan-Meier method, and the Cox model of regression analysis.
Female patients were older (P < .0005) and had higher prevalences of obesity (P < .0005), arterial hypertension (P < .0005), and diabetes (P < .0005). Emergency operations were also more frequent in this group (P < .027). There was no difference between the groups in the preoperative use of an intra-aortic balloon pump (IABP). The 2 groups were not significantly different with respect to 30-day mortality (1.1% versus 4%) or 7-day mortality (0.3% versus 0%). The 2 groups had comparable rates of IABP use postoperatively. Cognitive disturbances and strokes were rarely encountered (0.6% in men and 0.2% in women). In the early postoperative phase, women had more pulmonary complications (P < .014), and survival seemed to favor the male group during the follow-up period (P < .001). Further analysis with the Cox regression model with exclusion of confounding preoperative morbidity factors (more prevalent in group B) showed that the 2 groups had similar survival rates. As a group, women were 1.06 times more likely to die from a cardiac cause than men (P < .897).
The use of the pi-circuit, aorta no-touch technique is equally effective and safe for both sexes. Women are more prone to pulmonary complications in the early postoperative phase. The apparent difference in survival favoring men can be attributed to the higher prevalence of preoperative risk factors in women. In general, we consider the off-pump, aorta no-touch technique an effective method for lowering morbidity and mortality in the relatively high-risk female patient group.
在本研究中，我们评估了女性作为非体外循环冠状动脉搭桥术（OPCAB）主动脉免接触技术中的一个危险因素。
从2001年2月至2005年11月，我院1359例患者采用π-回路技术进行单纯冠状动脉血运重建，该技术包括：（1）心脏不停跳手术；（2）非体外循环冠状动脉搭桥术；（3）不接触主动脉；（4）使用复合移植物；（5）动脉血运重建。其中男性1159例（A组），女性200例（B组）。比较两组患者的术前危险因素、术中参数以及术后发病率和死亡率。随访时间为4至60个月。采用卡方检验、Fisher精确检验、Kaplan-Meier法以及Cox回归分析模型对数据进行分析。
女性患者年龄较大（P <.0005），肥胖（P <.0005）、动脉高血压（P <.0005）和糖尿病（P <.0005）的患病率较高。该组急诊手术也更为频繁（P <.027）。两组患者术前主动脉内球囊反搏（IABP）的使用情况无差异。两组患者30天死亡率（1.1%对4%）或7天死亡率（0.3%对0%）无显著差异。两组术后IABP的使用率相当。认知障碍和中风很少见（男性为0.6%，女性为0.2%）。术后早期，女性肺部并发症更多（P <.014），随访期间男性组生存率似乎更高（P <.001）。排除术前发病率较高（B组更常见）的混杂因素后，采用Cox回归模型进一步分析显示两组生存率相似。总体而言，女性因心脏原因死亡的可能性是男性的1.06倍（P <.897）。
π-回路主动脉免接触技术对男女两性同样有效且安全。术后早期女性更容易出现肺部并发症。男性生存率的明显差异可归因于女性术前危险因素的患病率较高。总体而言，我们认为非体外循环主动脉免接触技术是降低相对高危女性患者组发病率和死亡率的有效方法。
