Sex-specific long-term outcomes after combined valve and coronary artery surgery.
BACKGROUND
The purpose of this study is to compare sex-specific, long-term outcomes after combined valve and coronary artery bypass graft surgery (CABG).


METHODS
Between 1990 and 2000, 1,567 patients underwent combined valve and CABG surgery at our institution. Our surgical database was linked to a governmental administrative hospital discharge database and a registry of deaths to obtain long-term follow-up. All patients underwent CABG plus aortic (62%), mitral (31%), or multiple valve surgery (7%).


RESULTS
Women had more preoperative risk factors than men (namely, hypertension, diabetes mellitus, congestive heart failure, atrial fibrillation, and stroke; all p < 0.001). The prevalence of triple-vessel disease was the same between men and women, but women received fewer mammary grafts and fewer total bypass grafts (both p < 0.01). Women received fewer mitral valve repairs and more mitral valve replacements than men (p = 0.014). Length of follow-up was 5.3 +/- 3.2 years (mean +/- SD; range, 0 to 12.5) and was 99.8% complete. Both sexes had similar long-term survival rates. Women were at higher risk of stroke during follow-up (risk ratio = 1.52, 95% confidence interval: 1.1 to 2.1). There were no sex differences in rehospitalization for acute myocardial infarction (p = 0.9), heart failure (p = 0.4), redo cardiac surgery (p = 0.5), or endocarditis (p = 0.4).


CONCLUSIONS
Women have a higher preoperative risk profile than men undergoing combined valve and CABG surgery, but long-term survival rates are similar. Female sex is an independent predictor of stroke during follow-up. Further studies should focus on the cause of increased risk of stroke and methods of prevention.
Doenst
Torsten
T
Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Ontario, Canada.
Ivanov
Joan
J
Borger
Michael A
MA
David
Tirone E
TE
Brister
Stephanie J
SJ
D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000601:surgery; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology / Q000601:surgery