title: Does patient gender affect outcomes after concomitant coronary artery bypass graft and aortic valve replacement? An Australian Society of Cardiac and Thoracic Surgeons Database study.
abstract: OBJECTIVE
  Women undergoing isolated coronary artery bypass graft (CABG) surgery have been previously shown to be at an independently increased risk for post-operative morbidity and mortality. However, there are considerably less data on whether this trend remains true in patients undergoing concomitant aortic valve replacement (AVR) and CABG surgery. The aim of our study was to investigate this pertinent issue.
  
  
  METHODS
  Data obtained between June 2001 and December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program were retrospectively analysed. Demographic, operative data and post-operative complications were compared between male and female patients using χ(2) and t tests. Long-term survival analysis was performed using Kaplan-Meier survival curves and the log-rank test. Independent risk factors for short- and long-term mortality were identified using binary logistic and Cox regression, respectively.
  
  
  RESULTS
  Concomitant AVR and CABG surgery was undertaken in 2,563 patients; 31.8% were female. Female patients were older (mean age 76 vs. 73 years; p < 0.001) and presented more often with hypertension (p < 0.001) but less often with severely impaired ejection fraction (p < 0.001), peripheral vascular disease (p < 0.001) and triple vessel disease (p < 0.001). Women did not demonstrate an increased risk of 30-day mortality (4.8 vs. 3.3%) on univariate (p = 0.069) or multivariate (p = 0.236) analysis. Female gender was independently associated with post-operative myocardial infarction (p = 0.022) and red blood cell transfusion (p < 0.001). There was no difference in long-term survival between men and women on multivariate analysis (p = 0.413).
  
  
  CONCLUSIONS
  Female gender is not associated with poorer short- or long-term outcomes after concomitant CABG and AVR surgery.
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.forename: Chin-Leng
authors.initials: CL
authors.lastname: Poh
authors.forename: Diem T
authors.initials: DT
authors.lastname: Dinh
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
authors.forename: Gilbert C
authors.initials: GC
authors.lastname: Shardey
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Newcomb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001315:Australia / Q000453:epidemiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications; D012307:Risk Factors; D017678:Sex Distribution; D012955:Societies, Medical; D020521:Stroke / Q000150:complications; D016019:Survival Analysis; D016896:Treatment Outcome