Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Yıldırım/Bursa, Turkey.
Heart Surg Forum. 2021 Jul 28;24(4):E662-E669. doi: 10.1532/hsf.3929.
Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) is an effective but still controversial surgical strategy for the treatment of diffuse coronary artery disease. In this study, we aimed to investigate the impact of gender differences on operative and early postoperative results of patients who underwent CABG with CE.
This retrospective study included 141 patients who had undergone CE combined with CABG from January 2015 to December 2020, as well as 141 patients without CE as the control group. First, patients with and without CE were compared. Next, patients undergoing CE were divided into 2 groups according to gender (group 1, male patients; group 2, female patients).
Of the 141 patients who underwent CE combined with on-pump CABG, 95 (67.3%) were male, and median age was 66 years (range 58 to 71.2). Of the 141 patients who underwent isolated on-pump CABG, 99 (70.2%) were males, and median age was 63 years (range 41 to 80.4). The data for these 2 groups (with and without CE) were compared. Previous percutaneous coronary intervention (PCI), presence of diabetes mellitus, and perfusion time were significantly more common in the CE group. There were 95 patients in group 1, with a median age of 65 years (range 58 to 69), and 46 patients in group 2, with a median age of 66 (64 to 71.2). There were no difference between the groups in terms of age, body mass index, hyperlipidemia, chronic obstructive pulmonary disease, peripheral artery disease, or previous coronary intervention. The need for positive inotropic support and postoperative atrial fibrillation were found to be significantly more common in group 2 (P = .022 and .039, respectively). Defibrillation after releasing the aortic cross clamp was also significantly more common in group 2 (P = .025).
In our study, the need for defibrillation after aortic cross-clamp releasing in the perioperative period, the need for inotropic support and the incidence of atrial fibrillation in the post-operative period, increased significantly in the female gender. CE can be performed safely in both genders with acceptable mortality and morbidity rates.
冠状动脉内膜切除术（CE）联合冠状动脉旁路移植术（CABG）是一种有效的治疗弥漫性冠状动脉疾病的手术策略，但仍存在争议。本研究旨在探讨性别差异对接受 CE 联合 CABG 治疗的患者手术和早期术后结果的影响。
这是一项回顾性研究，纳入了 2015 年 1 月至 2020 年 12 月期间接受 CE 联合 CABG 治疗的 141 例患者，以及作为对照组的 141 例未接受 CE 治疗的患者。首先，比较了接受和未接受 CE 的患者。其次，根据性别将接受 CE 的患者分为 2 组（组 1：男性患者；组 2：女性患者）。
在接受体外循环 CE 联合 CABG 治疗的 141 例患者中，95 例（67.3%）为男性，中位年龄为 66 岁（范围 58 至 71.2）。在接受单纯体外循环 CABG 治疗的 141 例患者中，99 例（70.2%）为男性，中位年龄为 63 岁（范围 41 至 80.4）。比较了这两组（有和无 CE）的数据。CE 组中，既往经皮冠状动脉介入治疗（PCI）、糖尿病和灌注时间更为常见。组 1 中有 95 例患者，中位年龄为 65 岁（范围 58 至 69），组 2 中有 46 例患者，中位年龄为 66 岁（64 至 71.2）。两组在年龄、体重指数、高脂血症、慢性阻塞性肺疾病、外周动脉疾病或既往冠状动脉介入治疗方面无差异。发现组 2 中需要正性肌力支持和术后心房颤动的比例显著更高（分别为 P =.022 和 P =.039）。组 2 中主动脉阻断夹释放后除颤的比例也显著更高（P =.025）。
在我们的研究中，女性在围手术期释放主动脉夹后除颤的需要、正性肌力支持的需要以及术后心房颤动的发生率显著增加。CE 可以在男女两性中安全进行，死亡率和发病率可接受。
