Original article
Cardiovascular
Sex-Specific Long-Term Outcomes After Combined Valve and Coronary Artery Surgery

https://doi.org/10.1016/j.athoracsur.2005.11.052Get rights and content

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.

Section snippets

Material and Methods

Perioperative data for all patients undergoing cardiac surgery at the Toronto General Hospital were entered prospectively into a database. A total of 1567 consecutive patients undergoing combined CABG and valve surgery between January 1990 and October 2000 were identified. Long-term follow-up was obtained by linking our clinical database to a governmental administrative hospital discharge registry (the Canadian Institute of Health Information database) and to a governmental registry of deaths

Results

Table 1 shows the perioperative clinical variables in men versus women. Two thirds of patients were men. Women were significantly older and had more preoperative risk factors including hypertension, diabetes mellitus, and congestive heart failure. Women also had more angina and poorer NYHA classification before surgery. The prevalence of preoperative atrial fibrillation was almost twice as high in women (22%) as in men (13%), and the percentage of women who had had a stroke before surgery was

Comment

In the current study, we demonstrated that overall long-term survival is similar for men and women undergoing combined CABG and valvular surgery, despite an increased prevalence of risk factors in female patients. We also demonstrated a significantly increased risk of long-term stroke in women.

Few studies have investigated long-term sex differences in combined valve and CABG surgery [9, 10, 11]. In addition, such studies have been limited by small sample sizes. We previously compared

References (25)

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