ABSTRACT 65

EFFECT OF GENDER ON OUTCOMES OF BEATING HEART SURGERY

Jai H. Lee, MD, Michelle Capdeville, MD, Helen Murrell, BS.
University Hospitals Heart Institute, University Hospitals of Cleveland, Cleveland, Ohio

Purpose: A worse outcome has been observed in women undergoing CABG. To determine whether this gender difference  is applicable  in  off-pump coronary artery bypass surgery (OP-CAB), we compared outcomes among  183 consecutive patients undergoing OP-CAB over a 12 month period by a single surgeon (JHL).  This represented 94% of all isolated CABG during the same time period.

Results: The demographics were as follows: Women (W) ( n =69 )  were older than men (M) (n=114) (67.0 versus 65.5; p =  0.4 ). They had a greater prevalence of congestive heart failure ( 35% versus 16%; p = 0.01); were more frequently on IV NTG preoperatively ( 49% versus 32%; p = 0.03). A significant portion had documented MI < 7 days prior to OP-CAB ( women = 29%; men = 27%).

Overall mortality was  1.6% ( 3/ 187). In – hospital complications were as follows: deaths  2.9% in W and 0.9% in M ( p   =  ns  ); myocardial infarction 1.5% in   W and 1.8%% in M ( p = ns    ); major bleeding  0% in W and  3.5 %  in M ( p =ns ); stroke  1.5% % in W and 0% in M ( p =ns  ). There were no mediastinitis or renal failure in either group.

Extubation times ( 6.5 versus 7.7 hours; p = 0.009), SICU length of stay ( 37 hours versus 47 hours; p = 0.004) and length of stay ( 5.8 days versus 6.6  days; p = 0.014) were all significantly longer in women compared to  men.  When  OP-CAB women were compared to a matched cohort of women undergoing CABG, length of stay was similar, whereas  OP-CAB men realized a  19 % reduction in length of stay compared to men undergoing conventional CABG ( p = 0.01).

Conclusion:  Although women presenting for OP-CAB are older and have greater co-morbidities than men, similar clinical outcomes were noted. The elimination of cardiopulmonary bypass did not affect the recovery of women, whereas a substantial benefit was realized among men. This compelling finding suggests  that biochemical, hormonal, or pharmacokinetic factors in women  may neutralize the anticipated beneficial effect of avoiding cardiopulmonary bypass.