Lucia Torracca

Tenth International Symposium

HEART FAILURE & Co.CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING

ON FEMALE DISEASES

Milano9 - 10 aprile 2010

Il bypass aorto-coronarico:Il bypass aorto-coronarico:

più rischioso e meno efficace? più rischioso e meno efficace?

Direttore U.O. CardiochirurgiaDirettore U.O. Cardiochirurgia

A.O.U. Ospedali Riuniti “Umberto I- G. M. Lancisi- G. Salesi”A.O.U. Ospedali Riuniti “Umberto I- G. M. Lancisi- G. Salesi”

Presidio Monospecialistico “G. M. Lancisi”Presidio Monospecialistico “G. M. Lancisi”

AnconaAncona

L. TorraccaL. Torracca

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

Aldea Ann Thorac Surg 1999Single center consecutive 1743 pts

Gender profiling in CABG

Koch JTCVS 2003;126:204415,597 pts Cleveland Clinic

Operative mortalityOperative mortality

344,913 pts from STS database

Operative mortalityOperative mortality

Operative mortalityOperative mortality

Operative mortalityOperative mortality

Operative mortalityOperative mortality

Operative risk factorsOperative risk factors

Aldea Ann Thorac Surg 1999

Operative risk factorsOperative risk factors

Internal mammary artery useInternal mammary artery use

FEMALE vs MALE

64% vs 78% O’Connor 1993

65% vs 76% Edwards 1998

67% vs 80% Humphries 2007

83% vs 89% Bukkapatnam 2010

OutcomeOutcome

1113 pts followed for 6-8 weeks after CABG

Peric V. ICVTS 2010;10:232

QOL before and after CABG

Peric V. ICVTS 2010;10:232

QOL before and after CABG

Quality of lifeQuality 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-pumpGender and off-pump

Gender and off-pumpGender and off-pump

Female and leg wound complicationsFemale 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!Thanks for the attention!