Tenth International Symposium
HEART FAILURE & Co.
CARDIOLOGY SCIENCE UPDATE
FEMALE DOCTORS SPEAKING
ON FEMALE DISEASES
Milano
9 - 10 aprile 2010
Lucia Torracca
Il bypass aorto-coronarico:
più rischioso e meno efficace?
L. Torracca
Direttore U.O. Cardiochirurgia
A.O.U. Ospedali Riuniti “Umberto I- G. M. Lancisi- G. Salesi”
Presidio Monospecialistico “G. M. Lancisi”
Ancona
Preoperative risk profile
(women versus men)
•
•
•
•
•
•
•
•
Older
Diabetes/Obesity/Hypertension
Smaller body surface area
Lower hematocrit
Congestive heart failure/NYHA class IV
IV heparin/nitroglycerin
Urgent/emergent operation
Higher STS estimated mortality
Single center consecutive 1743 pts
Aldea Ann Thorac Surg 1999
Gender profiling in CABG
15,597 pts Cleveland Clinic
Koch JTCVS 2003;126:2044
Operative mortality
344,913 pts from STS database
Operative mortality
Operative mortality
Operative mortality
Operative mortality
Operative risk factors
Aldea Ann Thorac Surg 1999
Operative risk factors
Internal mammary artery use
FEMALE
vs
MALE
64%
vs
78%
65%
vs
76%
67%
vs
80%
83%
vs
89%
O’Connor
1993
Edwards
1998
Humphries
2007
Bukkapatnam
2010
Outcome
1113 pts followed for 6-8 weeks after CABG
QOL before and after CABG
Peric V. ICVTS 2010;10:232
QOL before and after CABG
Peric V. ICVTS 2010;10:232
Quality of life
Women may benefit of a more aggressive rehabilitation program
- 2 groups of patients 261 women and 261 men “computer-matched”
- All pts bilateral IMA graft
- Hospital mortality 3,4% vs 3,8% (women vs men)
Gender and off-pump
Gender and off-pump
Female and leg wound complications
Paletta Ann Thorac Surg 2000;70:492
Endoscopic vein harvesting
Yun JCTS 2005;129:496
• Increase the use of “at least” one or
“better” two mammary arteries
• Optimal management of blood glucose
level (100-150mg/dl)
• Intraop management of anemia (nadir
Ht>22 during CPB): reduce pump prime,
ultrafiltration
• Use of off-pump surgery ?
• Optimization of thyroxine treatment
• Hormone replacement therapy???
Thanks for the attention!