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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!