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Wong CWY, Li PWC, Yu DSF, Ho BMH, Chan BS. Estimated prevalence of frailty and prefrailty in patients undergoing coronary artery or valvular surgeries/procedures: A systematic review and proportional meta-analysis. Ageing Res Rev 2024; 96:102266. [PMID: 38462047 DOI: 10.1016/j.arr.2024.102266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The aging population has led to an increasing number of older patients undergoing cardiac surgeries/procedures. Frailty and prefrailty have emerged as important prognostic indicators among these patients. This proportional meta-analysis estimated the prevalence of frailty and prefrailty among patients undergoing cardiac surgery. METHODS We searched seven electronic databases for observational studies that used validated measure(s) of frailty and reported prevalence data on frailty and/or prefrailty in older patients undergoing coronary artery or valvular surgeries or transcatheter procedures. Meta-analyses were performed using a random-effects model. RESULTS One hundred and one articles involving 626,863 patients were included. The pooled prevalence rates of frailty and prefrailty were 28% (95% confidence interval [CI]: 23%-33%) and 40% (95% CI: 31%-50%), respectively, for patients scheduled for open-heart surgeries and 40% (95% CI: 36%-45%) and 43% (95% CI: 34%-53%), respectively, for patients undergoing transcatheter procedures. Frailty measured using a multidimensional approach identified a higher proportion of frail patients when compared with measures solely focused on physical frailty. Older age, female sex, and lower body mass index and hemoglobin concentrations were significantly associated with higher frailty prevalence. Moreover, countries with higher gross domestic product spent on healthcare exhibited a higher frailty prevalence. CONCLUSION Frailty represents a considerable health challenge among patients undergoing cardiac surgeries/procedures. Routine screening for frailty should be considered during perioperative care planning.
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Affiliation(s)
- Cathy W Y Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Polly W C Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong.
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Benjamin M H Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Bernice Shinyi Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
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2
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Wester ML, Olsthoorn JR, A Soliman-Hamad M, Houterman S, Roefs MM, Maas AHEM, ter Woorst JFJ. Sex-differences in outcome after off-pump coronary artery bypass grafting is age-dependent; data from the Netherlands Heart Registration. Heliyon 2024; 10:e23899. [PMID: 38205323 PMCID: PMC10776995 DOI: 10.1016/j.heliyon.2023.e23899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Background Women are known to have worse outcome after coronary artery bypass grafting (CABG) than men. Studies have shown that off-pump coronary artery bypass grafting (OPCAB) might benefit higher-risk patients, and therefore might also benefit women. We aimed to determine differences in early and late outcomes between sexes after OPCAB. Methods Data from all patients undergoing OPCAB, between 2013 through 2021 was retrieved from the Netherlands Heart Registration (NHR) database. Primary outcomes were early mortality, morbidity and late survival. We divided the population into subgroups based on age (aged ≥70 years or < 70 years) and sex. Results This study included 8,487 men and 2,170 women (total = 10,657). Female patients received fewer anastomoses (mean (SD)) women 2.38 (1.17) vs men 2.68 (1.23), p < 0.001) and total arterial revascularization was performed less frequently in women than in men (21.3 % versus 29.5 % respectively, p < 0.001).In the subgroup of patients <70 years, early mortality was 1.7 % in women and 0.6 % in men (p < 0.001). Survival rate at 5 years was 88.4 % in women and 91.1 % in men (p < 0.001). Female sex was associated with worse late survival in the subgroup <70 years (HR (95 % CI) 1.42 (1.10-1.83) p = 0.008). Conclusions Sex-differences in outcome after CABG persists in OPCAB surgery. However, these differences are solely present in the younger subgroup. In our data, women undergoing OPCAB surgery seem to be treated differently during surgery as compared to their male counter parts, further research is needed to analyze this finding.
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Affiliation(s)
- Mara-Louise Wester
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Jules R. Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | | | - Saskia Houterman
- Department of Education and Research, Catharina Hospital Eindhoven, the Netherlands
- Netherlands Heart Registration, Utrecht, the Netherlands
| | | | - Angela HEM. Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost FJ. ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
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Kim HL, Kim MA. Sex Differences in Coronary Artery Disease: Insights From the KoRean wOmen'S chest pain rEgistry (KoROSE). Korean Circ J 2023; 53:655-676. [PMID: 37880830 PMCID: PMC10625849 DOI: 10.4070/kcj.2023.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 10/27/2023] Open
Abstract
Interest in sex differences in coronary artery disease (CAD) has been steadily increasing. Concurrently, most of the data on these differences have primarily been Western-oriented. The KoRean wOmen'S chest pain rEgistry (KoROSE), started in 2011, has since published numerous research findings. This review aims to summarize the reported differences between men and women in CAD, integrating data from KoROSE. Cardiovascular risk in postmenopausal women escalates dramatically due to the decrease in estrogen levels, which normally offer cardiovascular protective effects. Lower estrogen levels can lead to abdominal obesity, insulin resistance, increased blood pressure, and endothelial dysfunction in older women. Upon analyzing patients with CAD, women are typically older and exhibit more cardiovascular risk factors than men. Diagnosing CAD in women tends to be delayed due to their symptoms being more atypical than men's. While in-hospital outcome was similar between sexes, bleeding complications after percutaneous coronary intervention occur more frequently in women. The differences in long-term prognosis for CAD patients between men and women are still a subject of ongoing debate. Pregnancy and reproductive factors also play a significant role as risk factors for cardiovascular disease in women. A notable sex disparity exists, with women found to use fewer cardiovascular protective drugs and undergo fewer interventional or surgical procedures than men. Additionally, women participate less frequently than men in clinical research. Through concerted efforts to increase awareness of sex differences and mitigate sex disparity, personalized treatment can be provided. This approach can ultimately improve patient prognosis.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
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4
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Sajja LR, Mannam G, Kamtam DN, Balakrishna N. Female gender does not have any significant impact on the early postoperative outcomes after coronary artery bypass grafting: a propensity-matched analysis. Indian J Thorac Cardiovasc Surg 2023; 39:231-237. [PMID: 37124586 PMCID: PMC10140232 DOI: 10.1007/s12055-022-01465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 01/28/2023] Open
Abstract
Purpose Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure performed in India. There are fundamental differences between males and females in the incidence and responses of the body to various diseases. These differences are noticeable, more so in conditions relating to cardiovascular health, particularly coronary artery disease (CAD). This study aims to assess the gender differences in the early postoperative outcomes following CABG. Methods Between April 1999 through February 2018, 13,415 patients underwent isolated CABG in our practice. Propensity score matching was performed to yield 1825 well-matched pairs in each gender. These groups were compared in terms of various early postoperative outcomes. Results There were no significant differences between females and males in terms of early postoperative composite outcomes (4.2% vs. 5.2%) (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.60-1.12, p = 0.213) of 30-day mortality, non-fatal myocardial infarction (MI), non-fatal cerebrovascular accidents (CVA), and need for renal replacement therapy (RRT), 30-day mortality (0.7% vs. 0.7%) (OR 1.11; 95%CI 0.50-2.45, p = 0.796), MI (2.7% vs. 3.1%) (OR 0.93; 95%CI 0.63-1.37, p = 0.708), CVA (0.4% vs. 0.8%) (OR 0.46; 95%CI 0.19-1.14, p = 0.096), and need for RRT (0.7% vs. 0.7%) (OR 0.88; 95%CI 0.40-1.93, p = 0.753). Conclusion Females have similar early postoperative outcomes compared to males in terms of composite outcomes of 30-day mortality, non-fatal MI, non-fatal CVA, and RRT among patients undergoing CABG. The outcomes are also similar when individually assessed. The off-pump technique has no additional benefit compared to the on-pump technique in females undergoing CABG.
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Affiliation(s)
- Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Hyderabad, 500034 India
- Division of Clinical Research in Cardiovascular Medicine/Surgery, Sajja Heart Foundation, Hyderabad, 500073 India
| | - Gopichand Mannam
- Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Hyderabad, 500034 India
| | | | - Nagalla Balakrishna
- Department of Biostatistics, Sajja Heart Foundation, Hyderabad, 500073 India
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5
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Matthews S, Buttery A, O'Neil A, Sanders J, Marasco S, Fredericks S, Martorella G, Keenan N, Ghanes A, Wynne R. Sex differences in mortality after first time, isolated coronary artery bypass graft surgery: a systematic review and meta-analysis of randomized controlled trials. Eur J Cardiovasc Nurs 2022; 21:759-771. [PMID: 35553670 DOI: 10.1093/eurjcn/zvac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/29/2022]
Abstract
AIM Reports of sex-specific differences in mortality after coronary artery bypass graft surgery (CABGS) are contradictory. The review aim was to determine whether CABGS is differentially efficacious than alternative procedures by sex, on short- and longer-term mortality. METHODS AND RESULTS EMBASE, CINAHL, Medline, and the Cochrane Library were searched. Inclusion criteria: English language, randomized controlled trials from 2010, comparing isolated CABGS to alternative revascularization. Analyses were included Mantel-Haenszel fixed-effects modelling, risk of bias (Cochrane RoB2), and quality assessment (CONSORT). PROSPERO Registration ID: CRD42020181673. The search yielded 4459 citations, and full-text review of 29 articles revealed nine studies for inclusion with variable time to follow-up. Risk of mortality for women was similar in pooled analyses [risk ratio (RR) 0.94, 95% confidence interval (CI) 0.84-1.05, P = 0.26] but higher in sensitivity analyses excluding 'high risk' patients (RR 1.22, 95% CI 1.01-1.48, P = 0.04). At 30 days and 10 years, in contrast to men, women had an 18% (RR 0.82, 95% CI 0.66-1.02, P = 0.08) and 19% (RR 0.81, 95% CI 0.69-0.95, P = 0.01) mortality risk reduction. At 1-2 years women had a 7% (RR 1.07, 95% CI 0.69-1.64, P = 0.77), and at 2-5 years a 25% increase in risk of mortality compared with men (RR 1.25, 95% CI 1.03-1.53, P = 0.03). Women were increasingly under-represented over time comprising 41% (30 days) to 16.7% (10 years) of the pooled population. CONCLUSION Meta-analysis revealed inconsistent sex-specific differences in mortality after CABGS. Trials with sex-specific stratification are required to ensure appropriate sex-differentiated treatments for revascularization.
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Affiliation(s)
- Stacey Matthews
- National Heart Foundation of Australia, Melbourne, VIC, Australia
- Melbourne School of Population & Global Health, University of Melbourne, Parkville, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Amanda Buttery
- National Heart Foundation of Australia, Melbourne, VIC, Australia
| | - Adrienne O'Neil
- Melbourne School of Population & Global Health, University of Melbourne, Parkville, VIC, Australia
- Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, iMPACT (the Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Charterhouse Square Barts, London, UK
- London School of Medicine and Dentistry Queen Mary University of London, London EC1 M 6BQ, UK
| | - Silvana Marasco
- Department of Surgery, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Suzanne Fredericks
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St, Toronto m5B 2K3, Canada
| | - Geraldine Martorella
- Tallahassee Memorial Healthcare Center for Research and Evidence-Based Practice, Florida State University, 98 Varsity Way, Tallahassee, FL 32304, USA
| | | | | | - Rochelle Wynne
- Royal Melbourne Hospital, Parkville, VIC, Australia
- School of Nursing and Midwifery, Deakin University, Gheringhap Street, Geelong, VIC 3220, Australia
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Ikonomidis JS. The recurring theme of gender difference in cardiac surgical outcomes. J Card Surg 2022; 37:2661-2662. [PMID: 35652890 DOI: 10.1111/jocs.16657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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7
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Wang E, Wang Y, Hu S, Yuan S. Impact of gender differences on hemostasis in patients after coronary artery bypass grafts surgeries in the context of tranexamic acid administration. J Cardiothorac Surg 2022; 17:123. [PMID: 35598028 PMCID: PMC9123662 DOI: 10.1186/s13019-022-01874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sex differences present in the blood management of patients after coronary artery bypass grafts (CABG) surgeries. Tranexamic acid (TXA) performed well in maintaining hemostasis during and after surgeries. However, the impact of sex differences on blood control after CABG in patients who received TXA was not investigated. METHODS Overall, 29,536 patients undergoing CABG with TXA administration from 2009 to 2019 in our hospital were included. Propensity score matching was performed. Finally, 6808 males and 6808 females were matched based on 23 covariates. RESULTS Female patients had a 0.36-fold lower incidence of reoperations due to major hemorrhage or cardiac tamponade compared to males (1.3% vs. 2.0%, p = 0.001, OR = 0.64, 95%CI = 0.49-0.84). Females had a median of 100 ml less blood loss in 24 h (median 360 vs. 460 ml, p < 0.0001), 150 ml less in 48 h (median 580 vs. 730 ml, p < 0.0001), and 180 ml less in total (median 760 vs. 940 ml, p < 0.0001) than male patients. The red blood cell (RBC) transfusion rate in female was 1.53-fold higher than that in male (33.0% vs. 21.6%, OR = 1.53, 95% CI = 1.43-1.63, p < 0.0001). Females also had higher morbidities than males after CABGs. CONCLUSIONS Females had less blood loss than males after CABG with the TXA treatment. Females still had a higher RBC transfusion rate after surgery. Morbidities in women were also higher than that in men.
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Affiliation(s)
- Enshi Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Xicheng District, Beijing, 100037, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Xicheng District, Beijing, 100037, China
| | - Shengshou Hu
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Xicheng District, Beijing, 100037, China.
| | - Su Yuan
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Xicheng District, Beijing, 100037, China.
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Parry M, Van Spall HG, Mullen KA, Mulvagh SL, Pacheco C, Colella TJF, Clavel MA, Jaffer S, Foulds HJ, Grewal J, Hardy M, Price JA, Levinsson AL, Gonsalves CA, Norris CM. The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 6: Sex- And Gender-Specific Diagnosis and Treatment. CJC Open 2022; 4:589-608. [PMID: 35865023 PMCID: PMC9294990 DOI: 10.1016/j.cjco.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/12/2022] [Indexed: 10/26/2022] Open
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Ullah R, Hayat MK, Shakil R, Jan A, Rustam Z, Awan NI. Effect of COVID-19 on the Cardiothoracic and Vascular Surgery Procedures Mix at a Tertiary Care Hospital. Cureus 2022; 14:e21522. [PMID: 35223298 PMCID: PMC8863118 DOI: 10.7759/cureus.21522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the effect of the COVID-19 pandemic on the cardiothoracic and vascular surgery procedures volume at a tertiary care hospital. Materials & Methods This cross-sectional retrospective study was carried out at a tertiary care hospital's Cardiothoracic and Vascular Surgery department. All the four-year surgical procedures data were reviewed from August 2017 to August 2021. After extracting data from the hospital database software, a databank was generated in SPSS version 24.0. Average cases per month were calculated, and the data were stratified into three groups, Pre-COVID, COVID, and Post-COVID. Tables and charts were generated for the representation of data. Results The total number of patients that underwent cardiovascular and thoracic procedures during the years 2017-2021 were 3,624, with male predominance (71.5%). Procedures were divided into Pre-COVID (68.5%), COVID (15.2%) and Post-COVID (16.3%) groups. Coronary Artery Bypass Grafting (CABG) was the most common procedure throughout the study duration (56.8%) and during the COVID-19 pandemic (29 procedures/month). Congenital Heart Surgeries (16.6%) and Valvular surgeries (11.5%) were next on the list. However, congenital heart surgeries were most affected during the pandemic (16 to 5 procedures/month). The average number of surgeries per month peaked at 2017 (135 procedures/month) and after that declined to its low of 46/month during the COVID-19 pandemic (The year 2020). Conclusion Cardiothoracic and Vascular Surgeries have significantly decreased during the COVID-19 pandemic, especially the Coronary Artery Bypass (CABG) and Congenital Heart Surgeries. CABG procedures, however, remained the highest performed surgery even during the pandemic due to their emergent nature. Thoracic, vascular, and combined surgeries have stayed almost constant. The year 2020 (COVID-19 year) saw the lowest number of surgeries performed per month. An uprising trend in the number of surgical procedures is seen in the post-pandemic time (2021).
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Translational model of vein graft failure following coronary artery bypass graft in atherosclerotic microswine. Gen Thorac Cardiovasc Surg 2021; 70:445-454. [PMID: 34699002 DOI: 10.1007/s11748-021-01725-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Vein graft failure is a major complication following coronary artery bypass graft surgery. There is no translational model to understand the molecular mechanisms underlying vein-graft failure. We established a clinically relevant bypass graft model to investigate the underlying pathophysiological mechanisms of vein-graft failure and identify molecular targets for novel therapies. METHODS Six female Yucatan microswine fed with high cholesterol diet underwent off-pump bypass, using superficial epigastric vein graft, which was anastomosed to an internal mammary artery and distal left anterior descending artery. Vein-graft patency was examined 10-months after bypass surgery by echocardiography, coronary angiography, and optical coherence tomography followed by euthanasia. Coronary tissues were collected for histomorphometry studies. RESULTS Atherosclerotic microswine were highly susceptible to sudden ventricular fibrillation with any cardiac intervention. Two out of six animals died during surgery due to ventricular fibrillation. Selection of the anesthetics and titration of their doses with careful use of inotropic drugs were the key to successful swine cardiac anesthesia. The hypotensive effects of amiodarone and the incidence of arrhythmia were avoided by the administration of magnesium sulfate. The vein-graft control tissue displayed intact endothelium with well-organized medial layer. The grafted vessels revealed complete occlusion and were covered with fibrous tissues. Expression of CD31 in the graft was irregular as the layers were not clearly defined due to fibrosis. CONCLUSION This model represents the clinical vein-graft failure and offers a novel platform to investigate the underlying molecular mechanisms of vein-graft disease and investigate novel therapeutic approaches to prevent its progression.
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Cho L, Kibbe MR, Bakaeen F, Aggarwal NR, Davis MB, Karmalou T, Lawton JS, Ouzounian M, Preventza O, Russo AM, Shroyer ALW, Zwischenberger BA, Lindley KJ. Cardiac Surgery in Women in the Current Era: What Are the Gaps in Care? Circulation 2021; 144:1172-1185. [PMID: 34606298 DOI: 10.1161/circulationaha.121.056025] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality for women in United States and worldwide. One in 3 women dies from cardiovascular disease, and 45% of women >20 years old have some form of CVD. Historically, women have had higher morbidity and mortality after cardiac surgery. Sex influences pathogenesis, pathophysiology, presentation, postoperative complications, surgical outcomes, and survival. This review summarizes current cardiovascular surgery outcomes as they pertain to women. Specifically, this article seeks to address whether sex disparities in research, surgical referral, and outcomes still exist and to provide strategies to close these gaps. In addition, with the growing population of women of reproductive age with cardiovascular disease and cardiovascular risk factors, indications for cardiac surgery arise in pregnant women. The current review will also address the unique issues associated with this special population.
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Affiliation(s)
- Leslie Cho
- Cleveland Clinic Heart and Vascular Institute, Ohio (L.C., F.B.,T.K.)
| | - Melina R Kibbe
- University of North Caroline Medical School, Chapel Hill (M.R.K.)
| | - Faisal Bakaeen
- Cleveland Clinic Heart and Vascular Institute, Ohio (L.C., F.B.,T.K.)
| | | | | | - Tara Karmalou
- Cleveland Clinic Heart and Vascular Institute, Ohio (L.C., F.B.,T.K.)
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12
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Peters SAE, Kluin J. Why do women do worse after coronary artery bypass grafting? Eur Heart J 2021; 43:29-31. [PMID: 34524421 DOI: 10.1093/eurheartj/ehab617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,The George Institute for Global Health, Imperial College London, London, UK.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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13
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Ter Woorst JF, Olsthoorn JR, Houterman S, van Straten BHM, Soliman-Hamad MA. Sex Difference in Long-Term Survival After Coronary Artery Bypass Grafting Is Age-Dependent. J Cardiothorac Vasc Anesth 2021; 36:1288-1295. [PMID: 34583854 DOI: 10.1053/j.jvca.2021.08.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Women undergoing coronary artery bypass grafting (CABG) demonstrate higher rates of postoperative morbidity and mortality than men. The aim of this study was to compare the patient profile and long-term outcomes of men and women undergoing isolated CABG. DESIGN A retrospective patient record study and propensity score-matched analysis. SETTING This single-center study was performed at Catharina Hospital in Eindhoven, The Netherlands. PARTICIPANTS The study comprised 17,483 patients, of whom 13,564 (77.6%) were men and 3,919 (22.4%) were women. INTERVENTIONS Coronary artery bypass grafting was performed between January 1998 and December 2015. MEASUREMENTS AND MAIN RESULTS The mean follow-up period was 8.8 ± 5.0 years. Women were older than men (67.7 ± 9.4 years v 63.9 ± 9.6 years, p < 0.001) and had lower preoperative hemoglobin levels. Early mortality (30-day) (2.8% v 1.9%; p < 0.001) and one-year mortality (5.2% v 3.8%; p < 0.001) rates were significantly higher in women than in men. Women demonstrated worse long-term survival than men only in the population younger than 70 years. After propensity score matching, female sex was not identified as an independent risk factor for long-term survival. CONCLUSIONS In the patient population, propensity score-matched analysis showed that female sex was not an independent risk factor for long-term survival after CABG. Poorer survival in women after CABG only was observed in patients <70 years of age.
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Affiliation(s)
- Joost F Ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Saskia Houterman
- Department of Research & Education, Catharina Hospital, Eindhoven, the Netherlands
| | - Bart H M van Straten
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
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14
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Review of the differences in outcomes between males and females after revascularization. Curr Opin Cardiol 2021; 36:652-660. [PMID: 34009807 DOI: 10.1097/hco.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review aims to compare outcomes of males and females undergoing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), off-pump CABG (OPCAB), minimally invasive direct CABG (MIDCAB), and robotic total endoscopic CABG (TECAB). RECENT FINDINGS Females demonstrated increased rates of morbidity and mortality post PCI and CABG. In studies that performed risk adjustments, these differences were reduced. Although inferior outcomes were observed for females in some measures, generally outcomes between males and females were comparable post OPCAB, MIDCAB, and TECAB. SUMMARY Previous literature has demonstrated that females undergoing coronary revascularization experience inferior postoperative outcomes when compared to their male counterparts. The discrepancies between males and females narrow, but do not disappear when preoperative risks are accounted for and when considering minimally invasive approaches such as MIDCAB, OPCAB, and TECAB. Minimally invasive cardiac surgery has demonstrated numerous benefits with reduced morbidity, mortality, and shorter recovery times. In patients with increased comorbidities, minimally invasive approaches confer a greater advantage. As females often fall within this category, it is paramount that the diagnosis and referral process be optimized to account for preoperative differences to provide the most beneficial approach if the disparity between the sexes is to be addressed.
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Solomon J, Moss E, Morin JF, Langlois Y, Cecere R, de Varennes B, Lachapelle K, Piazza N, Martucci G, Bendayan M, Piankova P, Hayman V, Ouimet MC, Rudski LG, Afilalo J. The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery. J Am Heart Assoc 2021; 10:e020219. [PMID: 34315236 PMCID: PMC8475706 DOI: 10.1161/jaha.120.020219] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The Essential Frailty Toolset (EFT) was shown to be easy to use and predictive of adverse events in patients undergoing aortic valve replacement procedures. The objective of this study was to evaluate the EFT in patients undergoing coronary artery bypass grafting procedures. Methods and Results The McGill Frailty Registry prospectively included patients ≥60 years of age undergoing urgent or elective isolated coronary artery bypass grafting between 2011 and 2018 at 2 hospitals. The preoperative EFT was scored 0 to 5 points as a function of timed chair rises, Mini-Mental Status Examination, serum albumin, and hemoglobin. The primary outcome was all-cause mortality assessed by Cox proportional hazards regression. The cohort consisted of 500 patients with a mean age of 71.4 ± 6.4 years, of which 27% presented with acute coronary syndromes requiring urgent surgery. The mean EFT was 1.3 ± 1.1 points, 132 (26%) were nonfrail, 298 (60%) were prefrail, and 70 (14%) were frail. Over a median follow-up of 4.0 years, 78 deaths were observed. In nonfrail, prefrail, and frail patients, survival at 1 year was 98%, 95%, and 91%, and at 5 years was 89%, 83%, and 63% (P<0.001). After adjustment, each incremental EFT point was associated with a hazard ratio of 1.28 (95% CI, 1.05-1.56) and frail patients had a 3-fold increase in all-cause mortality. Conclusions The EFT is a pragmatic and highly prognostic tool to assess frailty and guide decisions for coronary artery bypass grafting in older adults. Furthermore, the EFT may be actionable through targeted interventions such as cardiac rehabilitation and nutritional optimization.
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Affiliation(s)
- Joshua Solomon
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada
| | - Emmanuel Moss
- Division of Cardiac Surgery Jewish General HospitalMcGill University Montreal QC Canada
| | - Jean-Francois Morin
- Division of Cardiac Surgery Jewish General HospitalMcGill University Montreal QC Canada
| | - Yves Langlois
- Division of Cardiac Surgery Jewish General HospitalMcGill University Montreal QC Canada
| | - Renzo Cecere
- Division of Cardiac Surgery McGill University Health Centre Montreal QC Canada
| | - Benoit de Varennes
- Division of Cardiac Surgery McGill University Health Centre Montreal QC Canada
| | - Kevin Lachapelle
- Division of Cardiac Surgery McGill University Health Centre Montreal QC Canada
| | - Nicolo Piazza
- Division of Cardiology McGill University Health Centre Montreal QC Canada
| | - Giuseppe Martucci
- Division of Cardiology McGill University Health Centre Montreal QC Canada
| | - Melissa Bendayan
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada
| | - Palina Piankova
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada
| | - Victoria Hayman
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada
| | | | - Lawrence G Rudski
- Division of Cardiology Jewish General HospitalMcGill University Montreal QC Canada
| | - Jonathan Afilalo
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada.,Research InstituteMcGill University Health Centre Montreal QC Canada.,Division of Cardiology Jewish General HospitalMcGill University Montreal QC Canada
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Barili F, D'Errigo P, Rosato S, Biancari F, Forti M, Pagano E, Parolari A, Gellini M, Badoni G, Seccareccia F. Impact of gender on 10-year outcome after coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2021; 33:510-517. [PMID: 34000041 DOI: 10.1093/icvts/ivab125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our goal was to evaluate the impact of gender on the 10-year outcome of patients after isolated coronary artery bypass grafting (CABG) included in the Italian nationwide PRedictIng long-term Outcomes afteR Isolated coronary arTery bypass surgery (PRIORITY) study. METHODS The PRIORITY project was designed to evaluate the long-term outcomes of patients who underwent CABG and were included in 2 prospective multicentre cohort studies. The primary end point of this analysis was major adverse cardiac and cerebrovascular events. Baseline differences between the study groups were balanced with propensity score matching and inverse probability of treatment. Time to events was analysed using Cox regression and competing risk analysis. RESULTS The study population comprised 10 989 patients who underwent isolated CABG (women 19.6%). Propensity score matching produced 1898 well-balanced pairs. The hazard of major adverse cardiac and cerebrovascular event was higher in women compared to men [adjusted hazard ratio (HR) 1.13, 95% confidence interval (CI) 1.03-1.23; P = 0.009]. The incidence of major adverse cardiac and cerebrovascular event in women was significantly higher at 1 year (HR 1.31, 95% CI 1.11-1.55; P < 0.001) and after 1 year (HR 1.11, 95% CI 1.00-1.24; P = 0.05). Mortality at 10 years in the matched groups was comparable (HR 1.04, 95% CI 0.93-1.16; P = 0.531). Women have significantly a higher 10-year risk of myocardial infarction (adjusted HR 1.40, 95% CI 1.17-1.68; P = 0.002) and percutaneous coronary intervention (adjusted HR 1.32, 95% CI 1.10-1.59; P = 0.003). CONCLUSIONS The present study documented an excess of non-fatal cardiac events after CABG among women despite comparable 10-year survival with men. These findings suggest that studies investigating measures of tertiary prevention are needed to decrease the risk of adverse cardiovascular events among women.
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Affiliation(s)
- Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - Marco Forti
- Agenzia Regionale per i Servizi Sanitari Regionali, Rome, Italy
| | - Eva Pagano
- Department of Epidemiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandro Parolari
- Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, University of Milan, S. Donato Milanese, Italy
| | - Mara Gellini
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Gabriella Badoni
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Italian Health Institute, Rome, Italy
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Urbanowicz T, Michalak M, Olasińska-Wiśniewska A, Haneya A, Straburzyńska-Migaj E, Bociański M, Jemielity M. Gender differences in coronary artery diameters and survival results after off-pump coronary artery bypass (OPCAB) procedures. J Thorac Dis 2021; 13:2867-2873. [PMID: 34164178 PMCID: PMC8182499 DOI: 10.21037/jtd-20-3356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiovascular disease is still the leading cause of death among men and women. The gender related survival differences following off-pump surgery was the subject of the study with relation to coronary arteries diameters according to sizes of intraluminal shunts applied during surgery. Methods We retrospectively collected data of 2,772 patients who were referred for surgical revascularization in our department between 2010 and 2018 with mean follow up period of 76 months. Patients underwent coronary artery bypass grafting with off-pump technique (OPCAB) with intraluminal shunts application during each anastomosis. Results The multivariate Cox’s proportional hazards model revealed male sex as significant all-cause mortality risk factor [hazard ratio (HR) =4.62; 95% confidence interval (CI): (3.12–6.83)]. The survival proportion was significantly lower in male than female (73% vs. 94%; P<0.0001) within 130 months of follow up despite favorable results of coronary artery diameters. Mean ± standard deviation (SD) diameters of coronary arteries measured by shunts applied during off-pump revascularization were 1.81±0.28 vs. 1.7±0.26 mm (P<0.0001) for left anterior descending artery (LAD) anastomosis, 1.78±0.27 vs. 1.71±0.29 mm (P<0.0001) for circumflex artery (Cx) anastomosis and 1.77±0.28 vs. 1.72±0.31 mm (P>0.05) for right coronary artery (RCA) anastomosis in men and women subgroups, respectively. Conclusions Female sex is associated with better overall late survival following surgical revascularization despite smaller diameters of coronary arteries in direct measurement with the use of intraluminal shunt application.
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Affiliation(s)
- Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasińska-Wiśniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Assad Haneya
- Klinik für Herz- und Gefäßchirurgie, Universitatklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Michał Bociański
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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Chang HH, Chen PL, Leu HB, Chen IM, Wu NY, Chen YH. Sex difference in the prognostic role of body composition parameters in Taiwanese patients undergoing transcatheter aortic valve implantation. BMC Cardiovasc Disord 2020; 20:283. [PMID: 32522169 PMCID: PMC7288684 DOI: 10.1186/s12872-020-01569-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open
Abstract
Background Evidence on association between body composition and outcomes of transcatheter aortic valve implantation (TAVI) is limited for Asian patients. This study investigated the prognostic role of body composition parameters in Taiwanese patients undergoing TAVI. Materials and methods Data of consecutive patients undergoing TAVI for severe aortic stenosis between May 1, 2010 and August 31, 2019 were prospectively collected in this observational study. The association between body composition parameters (body mass index [BMI], body surface area [BSA], lean body mass [LBM], and LBM index) and cumulative mortality was analyzed using Cox proportional hazard regression model. Results A total of 221 patients (mean age 81.4 years), including 125 (56.6%) males, were included with median follow-up duration of 23.8 months. In males, multivariate analysis revealed that higher BMI (P = 0.035), BMI ≥ 20 kg/m2 (P = 0.026), and higher LBM index (P = 0.023) significantly predicted lower overall all-cause cumulative mortality. In females, none of the body composition parameters was significantly associated with all-cause cumulative mortality. Paradoxical association between BMI and estimated all-cause cumulative mortality was only significant among male patients. Conclusion In Taiwanese TAVI patients, the prognostic effects of BMI and LBM index on cumulative mortality were only observed in males, not in females. Sex differences must be considered when stratifying risk among patients undergoing TAVI.
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Affiliation(s)
- Hsiao-Huang Chang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Bang Leu
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217, Taiwan
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hwa Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217, Taiwan.
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Bechtel AJ, Huffmyer JL. Gender Differences in Postoperative Outcomes After Cardiac Surgery. Anesthesiol Clin 2020; 38:403-415. [PMID: 32336392 DOI: 10.1016/j.anclin.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Women presenting for cardiac surgery tend to be older and have hypertension, diabetes, and overweight or underweight body mass index than men. Despite improvements in surgical techniques and medications, women have increased risk for morbidity and mortality after multiple types of cardiac surgery. Women presenting for transcatheter aortic valve replacement are older and frailer than men, and have increased risk of intraoperative complications, but lower mortality at mid- and long-term ranges compared with men. Adherence to recovery and rehabilitation from cardiac surgery is challenging for women. Solutions should focus on increased family support, and use of group exercise and activities.
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Affiliation(s)
- Allison J Bechtel
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA.
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Commentary: Looking before leaping. J Thorac Cardiovasc Surg 2019; 161:634-635. [PMID: 31757462 DOI: 10.1016/j.jtcvs.2019.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 11/20/2022]
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