Resultados imediatos da cirurgia de revascularização miocárdica: comparação entre homens e mulheres

Abstract

Several studies [1][2][3][4][5][6][7][8][9][10][11] have shown that women who undergo myocardial revascularization surgery (MR) have a greater in-hospital mortality rate and a greater rate of complications, as compared with those of men, the first of those studies being attributed to Bolooki et al 12 .Several studies 1,10,13 have reported a similar survival after surgery for men and women, while others 7,14,15 have reported a shorter survival for women, whose rates of angina recurrence are greater 16 and whose graft patency is lower 1,17 . On average, the surgical mortality rate for women has been reported as twice that of men. The reasons for that have not been completely clarified, and several hypotheses have been discussed. Studies 11 have shown that, on the occasion of surgery, women compared with men are usually older and have a greater number of risk factors and also of symptoms. Some of those factors, as well as the more unstable symptomatology, are known to relate to greater surgical morbidity and mortality rates 18 . The greater technical difficulty during surgery, with greater rates of complications and in-hospital mortality, has been attributed to the smaller body surface area, and, consequently, lower coronary diameter in the female sex, the anatomical aspects being the major thing responsible for the worse results in women 1,6,19,20 . Studies on autopsy 21 , angiography 22 , and in vivo with intracoronary ultrasound 23 have confirmed that women have coronary arteries of lower caliber than men do.Women have also been shown to receive fewer arterial grafts, mainly internal thoracic artery grafts 11 , which have been related in the literature to a lower mortality rate and fewer complications, even in the in-hospital phase 24 , in addition to their already known benefit in long-term evolution 25 . The reasons why the female sex has been less favored by these grafts have not been completely clarified.In some studies, after correction for age and risk factors, female sex has no longer been a prognosis for greater in-hospital mortality, indicating that those factors, and not sex per se, account for the greater surgical risk 5 . The same occurs with the analyses with the same correction, which consider, in addition to clinical factors, body surface and coronary diameter, showing that, in reality, "smaller" people, both men and women, have greater mortality and complication rates 1,6,10,19,20 . Those conclusions, however, have not been uniform, and, in some reports, even after correcting for these clinical and anatomical factors, the female sex has remained related to greater mortality (OR = 1.82; 95% CI = 1.07 to 3.11; P = 0.028) and urgent/emergency surgery (OR = 2.85; 95% CI = 1.32 to 6.14; P = 0.008). ConclusionThe female sex had a greater surgical mortality; this, however, was not an independent prognostic factor for death. The use of thoracic artery grafts proved to be protective. Older patients with renal failure in an emergency situation had greater indices of in-hospital death. Keywords myocardia...

Características clínico-demográficas de pacientes submetidos a cirurgia de revascularização do miocárdio e sua relação com a mortalidade

“…The fact that they tend to be older, with lower body mass and smaller coronary arteries, causes technical difficulties during surgery. Women also present with more comorbidities, such as DM (female: 44% vs. male: 32.5%), valve abnormalities (female: 14.9% vs. male: 8.9%), unstable angina (female: 11.3% vs. male: 7.9%) and hypertension (female: 71.0% vs. male: 49, 0%) [4,6,7,10,14,[28][29][30][31].…”

Complicações que aumentam o tempo de permanência na unidade de terapia intensiva na cirurgia cardíaca

“…The complications of cardiac surgery may be related to pre-existing diseases such as previous pulmonary diseases, COPD, asthma, smoking [3,7,23,25], advanced age [7,16,18,23,30], poor nutritional status [38], obesity, diabetes [16,39], among others [25]. Among the most common complications we found atrial fibrillation and flutter, pulmonary congestion and stroke [7,15,22].…”

Influências temporais nas características e fatores de risco de pacientes submetidos a revascularização miocárdica

“…Women are also older when revascularization procedures are considered, have a higher number of comorbidities, a higher incidence of mechanical complications with acute coronary syndrome (ventricular septal rupture, severe acute mitral regurgitation) 20 as well as higher hospital mortality rates and higher cardiac morbidity rates 22,23 . Nevertheless, the benefits of interventions for ischemic diseases appear to be the same for both men and women 20 .…”