Szczechowicz Marcin P, Mkalaluh Sabreen, Torabi Saeed, Easo Jerry, Karck Matthias, Weymann Alexander
Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Essen Huttrop Heart Center, Herwarthstrasse100, 45138 Essen, Germany.
Indian J Thorac Cardiovasc Surg. 2020 Nov;36(6):580-590. doi: 10.1007/s12055-020-00982-5. Epub 2020 Aug 12.
Bypass surgery in patients undergoing cardiogenic shock caused by acute coronary syndrome is one of the most urgent and often performed cardiac operations. It remains unclear if patients gender independently influences the outcome. Literature reveals that females and males primarily differ from each other with regard to many important preoperative characteristics. Our objective was to compare the outcome and postoperative courses of both genders, using matched samples, eliminating these preoperative differences.
Between 2007 and 2015, 491 patients in cardiogenic shock underwent urgent bypass surgery in our institution. To assess the impact of gender on outcomes, we performed a propensity score matching to create two groups [males and females] which were matched for age, severity of shock, coronary artery disease morphology, and other comorbidities. Two groups were created: (1) 103 female and (2) 103 male patients. We analyzed the outcomes, complications and potential mortality predictors.
Most of the patients had three-vessel disease (70.1%, = 344) with proximal left anterior descending lesion (88%, = 432). Our study showed no differences between female and male patients regarding choice of conduits, number of anastomosed vessels, and outcome. Acute kidney injury (AKI) occurred significantly more often in female patients and pericardial tamponade in their male counterparts. There were no differences regarding other major complications.
Gender does not appear to influence long-term outcomes in the study sample. Female gender is an independent risk factor for postoperative AKI. Other complications occurred with comparable rates in both genders. Exertion tolerance in the follow-up period was similar between genders.
对因急性冠状动脉综合征导致心源性休克的患者进行搭桥手术是最紧急且常施行的心脏手术之一。患者性别是否独立影响手术结果仍不明确。文献表明，女性和男性在许多重要的术前特征方面存在主要差异。我们的目的是通过匹配样本消除这些术前差异，比较两性的手术结果和术后病程。
2007年至2015年期间，我院491例心源性休克患者接受了紧急搭桥手术。为评估性别对手术结果的影响，我们进行了倾向评分匹配，以创建两组（男性和女性），使其在年龄、休克严重程度、冠状动脉疾病形态和其他合并症方面相匹配。创建了两组：（1）103例女性患者和（2）103例男性患者。我们分析了手术结果、并发症及潜在的死亡预测因素。
大多数患者患有三支血管病变（70.1%，n = 344），左前降支近端病变（88%，n = 432）。我们的研究表明，女性和男性患者在血管桥选择、吻合血管数量和手术结果方面无差异。女性患者急性肾损伤（AKI）的发生率显著更高，而男性患者心包填塞的发生率更高。在其他主要并发症方面无差异。
在本研究样本中，性别似乎不影响长期手术结果。女性是术后发生AKI的独立危险因素。两性其他并发症的发生率相当。随访期间两性的运动耐量相似。
