Emmert Maximilian Y, Salzberg Sacha P, Seifert Burkhardt, Schurr Ulrich P, Odavic Dragan, Reuthebuch Oliver, Genoni Michele
Department of Cardiac and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Interact Cardiovasc Thorac Surg. 2010 May;10(5):737-41. doi: 10.1510/icvts.2009.220277. Epub 2010 Jan 5.
Female gender is an established risk factor for worse outcomes after cardiac surgery. Avoiding cardiopulmonary bypass (CPB) for coronary bypass grafting has an unknown effect on gender differences. Herein, we evaluate if gender has an impact on outcomes after modern off-pump coronary artery bypass grafting (OPCAB). From 2002 to 2007, we analyzed 983 patients (male: n=807/female: n=176) who underwent OPCAB with symptomatic multi-vessel disease at our institution. The link between gender and outcome was assessed by multivariate analysis and logistic regression. A composite endpoint was constructed from: 30-day-mortality, renal failure, prolonged intensive care unit (ICU) stay, neurological complications, use of intra-aortic balloon pump (IABP) and conversion to CPB. Mortality was 3.2% in women vs.1.8% in men (P=0.15) and the EuroSCORE was significantly correlated to gender (6.8 vs. 5.2; P<0.001), even after correction (P=0.036). Significant more occurrence of the composite endpoint was noted in women (39.8% vs. 29.0%; P=0.007) whereas for men the risk was much lower [odds ratio (OR) 0.65; 95% confidence interval (CI) 0.46-0.92; P=0.015]. For both genders the logistic regression revealed a risk increase of 15% per one-point-increase of EuroSCORE (corrected) (OR 1.15; 95% CI: 1.10-1.19; P<0.0001). Women had more frequently a prolonged stay at ICU (P=0.006) and had a higher stroke rate (2.3% vs. 1.2%; P=0.29). Complete revascularization was achieved similarly (95% vs. 94%; P=0.93). OPCAB offers low mortality and excellent clinical outcome. Women are more likely to experience postoperative complications. Even if partially neutralized by avoiding CPB, gender differences remain present with modern OPCAB strategies.
女性是心脏手术后预后较差的一个既定风险因素。在冠状动脉搭桥术中避免使用体外循环（CPB）对性别差异的影响尚不清楚。在此，我们评估性别对现代非体外循环冠状动脉搭桥术（OPCAB）后预后的影响。2002年至2007年，我们分析了在我院接受有症状多支血管病变OPCAB的983例患者（男性：n = 807/女性：n = 176）。通过多因素分析和逻辑回归评估性别与预后之间的联系。构建了一个综合终点，包括：30天死亡率、肾衰竭、重症监护病房（ICU）住院时间延长、神经系统并发症、主动脉内球囊反搏（IABP）的使用以及转为CPB。女性的死亡率为3.2%，男性为1.8%（P = 0.15），欧洲心脏手术风险评估系统（EuroSCORE）与性别显著相关（6.8对5.2；P < 0.001），即使校正后也是如此（P = 0.036）。女性中综合终点的发生率显著更高（39.8%对29.0%；P = 0.007），而男性的风险则低得多[比值比（OR）0.65；95%置信区间（CI）0.46 - 0.92；P = 0.015]。对于两性，逻辑回归显示校正后的EuroSCORE每增加1分，风险增加15%（OR 1.15；95% CI：1.10 - 1.19；P < 0.0001）。女性在ICU的住院时间更常延长（P = 0.006），且中风发生率更高（2.3%对1.2%；P = 0.29）。完全血运重建的实现情况相似（95%对94%；P = 0.93）。OPCAB的死亡率低且临床预后良好。女性更易出现术后并发症。即使通过避免CPB部分抵消了差异，但现代OPCAB策略中性别差异仍然存在。
