Lucia Torracca HEART FAILURE & Co. Milano 9 - 10 aprile 2010 Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile 2010 Lucia Torracca
Il bypass aorto-coronarico: più rischioso e meno efficace? L. Torracca Direttore U.O. Cardiochirurgia A.O.U. Ospedali Riuniti “Umberto I- G. M. Lancisi- G. Salesi” Presidio Monospecialistico “G. M. Lancisi” Ancona
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 Single center consecutive 1743 pts Aldea Ann Thorac Surg 1999
Gender profiling in CABG 15,597 pts Cleveland Clinic Koch JTCVS 2003;126:2044
Operative mortality 344,913 pts from STS database 5
Operative mortality 6
Operative mortality 7
Operative mortality 8
Operative mortality 9
Operative risk factors Aldea Ann Thorac Surg 1999 10
Operative risk factors Internal mammary artery use FEMALE vs MALE 64% 78% O’Connor 1993 65% 76% Edwards 1998 67% 80% Humphries 2007 83% 89% Bukkapatnam 2010 11
Outcome 1113 pts followed for 6-8 weeks after CABG 12
QOL before and after CABG Peric V. ICVTS 2010;10:232
QOL before and after CABG Peric V. ICVTS 2010;10:232
Quality of life 15
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-pump 22
Gender and off-pump 23
Female and leg wound complications Paletta Ann Thorac Surg 2000;70:492 24
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 26
Use of off-pump surgery ? Optimization of thyroxine treatment Hormone replacement therapy??? 27
Thanks for the attention!