Perek Bartłomiej, Aboul-Hassan Sleiman Sebastian, Hrapkowicz Tomasz, Gocoł Radosław, Deja Marek, Kapelak Bogusław, Rogowski Jan, Widenka Kazimierz, Krasoń Marcin, Maruszewski Bohdan, Cichoń Romuald, Jemielity Marek, Jasiński Marek
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 1/2 Dluga Str, 61-848, Poznan, Poland.
Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland.
Sci Rep. 2025 May 26;15(1):18299. doi: 10.1038/s41598-025-02892-1.
Despite widespread implementation of intravascular techniques in cardiovascular medicine, combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) have still been standard of surgical treatment. A purpose of this multicenter retrospective cohort study was to assess an impact of female sex on early outcomes and late survival rate following simultaneous AVR + CABG. This study comprised 12,626 patients (30.1% females; 69.9% males) that underwent AVR + CABG in 2006 through 2020. Primary endpoint was late survival. Thirty-day mortality and morbidity rates were also evaluated. In order to reduce an impact of inherent confounders, a propensity score (PS) matching was applied. PS matching selected 3,443 pairs and both gender groups were well balanced for baseline and operative characteristics. Women had higher 30-day mortality (OR: 1.42 (1.17-1.73), p < 0.001), more prevalent respiratory failure (OR: 1.28 (1.06-1.55), p = 0.01) and increased risk of postoperative application of cardiac support devices (OR: 1.46 (1.09-1.94), p = 0.01), but reduced incidence of re-thoracotomy due to bleeding compared to men (OR: 0.8 (0.67-0.95), p = 0.01). A probability of survival of 4-year (76.2 vs. 76.1%) and 8-year (58.8 vs. 57.0%) follow-up was comparable between females and males, respectively. Women undergoing aortic valve replacement with concomitant artery bypass grafting presented worse early outcomes but comparable long-term survival to men.
尽管血管内技术在心血管医学中已广泛应用，但主动脉瓣置换术（AVR）和冠状动脉旁路移植术（CABG）联合手术仍是标准的外科治疗方法。这项多中心回顾性队列研究的目的是评估女性性别对同期AVR + CABG术后早期结局和晚期生存率的影响。本研究纳入了2006年至2020年期间接受AVR + CABG手术的12,626例患者（女性占30.1%；男性占69.9%）。主要终点是晚期生存。还评估了30天死亡率和发病率。为了减少内在混杂因素的影响，采用了倾向评分（PS）匹配。PS匹配选出了3443对，两个性别组在基线和手术特征方面达到了良好的平衡。女性的30天死亡率更高（OR：1.42（1.17 - 1.73），p < 0.001）），呼吸衰竭更为普遍（OR：1.28（1.06 - 1.55），p = 0.01），术后应用心脏支持设备的风险增加（OR：1.46（1.09 - 1.94），p = 0.01），但与男性相比，因出血导致再次开胸手术的发生率降低（OR：0.8（0.67 - 0.95），p = 0.01）。女性和男性在4年（76.2%对76.1%）和8年（58.8%对57.0%）随访时的生存概率分别相当。接受主动脉瓣置换术并同期进行动脉旁路移植术的女性早期结局较差，但长期生存率与男性相当。
