1. 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
aprile 2010
Lucia Torracca

2. 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

3. 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

4. Gender profiling in CABG
15,597 pts Cleveland Clinic
Koch JTCVS 2003;126:2044

5. Operative mortality
344,913 pts from STS database 5

6. Operative mortality 6

7. Operative mortality 7

8. Operative mortality 8

9. Operative mortality 9

10. Operative risk factors
Aldea Ann Thorac Surg 1999 10

11. 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

12. Outcome
1113 pts followed for 6-8 weeks after CABG 12

13. QOL before and after CABG
Peric V. ICVTS 2010;10:232

14. QOL before and after CABG
Peric V. ICVTS 2010;10:232

15. Quality of life 15

17. Women may benefit of a more aggressive rehabilitation program

18. - 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)

22. Gender and off-pump 22

23. Gender and off-pump 23

24. Female and leg wound complications
Paletta Ann Thorac Surg 2000;70:492 24

25. Endoscopic vein harvesting
Yun JCTS 2005;129:496

26. Increase the use of “at least” one or “better” two mammary arteries
Optimal management of blood glucose level ( mg/dl)
Intraop management of anemia (nadir Ht>22 during CPB): reduce pump prime, ultrafiltration 26

27. Use of off-pump surgery ? Optimization of thyroxine treatment
Hormone replacement therapy??? 27

28. Thanks for the attention!