Gender differences in pediatric cardiac surgery: The cardiologist's perspective

Miller‐Hance, Wanda C.; Tacy, Theresa A.

doi:10.1016/j.jtcvs.2004.04.008

Cited by 23 publications

(15 citation statements)

References 29 publications

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“…Higher mortality in women undergoing congenital heart disease surgery has been reported, which was not explained by a higher prevalence of comorbid conditions or hormonal differences, and increased morbidity is also observed in critically ill women undergoing tracheostomy. 2,5,7,20 We observed no statistically significant sex differences in midbrain length or comorbid conditions. However, sleep apnea tended to be more commonly diagnosed in our female patients (19% vs 13%).…”

Section: Discussionmentioning

confidence: 50%

Risk factors of sudden death in young adult patients with myelomeningocele

Jernigan¹,

Berry²,

Graham

et al. 2012

PED

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Object Although survival for patients with myelomeningocele has dramatically improved in recent decades, the occasional occurrence of sudden, unexplained death in young adult patients with myelomeningocele has been noted by the authors. This study was undertaken to determine risk factors for sudden death in this population. Methods The authors performed a retrospective chart review of patients born between 1978 and 1990 who received care at Children's Hospital Boston. The relationship between sudden death and patient demographics, presence of CSF shunt and history of shunt revisions, midbrain length as a marker for severity of hindbrain malformation, seizures, pulmonary and ventilatory dysfunction, body mass index, scoliosis, renal dysfunction, and cardiac disease was evaluated using the t-test, Fisher exact test, and logistic regression analysis. Results The age range for 106 patients in the study cohort was 19–30 years, with 58 (54.7%) women and 48 (45.3%) men. Six patients, all of whom were young women, experienced sudden death. In multivariate analysis, female sex, sleep apnea, and midbrain elongation ≥ 15 mm on MR imaging remained significantly associated with a higher risk of sudden death. These risk factors were cumulative, and female patients with sleep apnea and midbrain length ≥ 15 mm had the greatest risk (adjusted risk ratio 24.0, 95% CI 7.3–79.0; p < 0.05). No other comorbidities were found to significantly increase the risk of sudden death. Conclusions Young adult women with myelomeningocele are at significantly increased risk of sudden death in the setting of midbrain elongation and sleep apnea. Further investigation is needed to determine the benefit of routine screening to identify at-risk patients for closer cardiopulmonary monitoring and treatment.

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Section: Discussionmentioning

confidence: 50%

Risk factors of sudden death in young adult patients with myelomeningocele

Jernigan¹,

Berry²,

Graham

et al. 2012

PED

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“…Vice versa, no sex-related differences have been observed for ventricular septal defect (VSD), partial or complete atrio-ventricular canal defect, partial or total anomalous pulmonary venous return, aortopulmonary window, or an anomalous origin of the left coronary artery from the pulmonary artery. 7 However, a few limited case series report a predominance of atrioventricular canal defects among the female sex. 8,9 Obstructive heart disease Ebstein's anomaly of the tricuspid valve (M/F: 1 : 1.6) and stenosis/atresia of the pulmonary valve are more frequently manifested by women, whereas men display a marked predisposition for left cardiac obstructions (hypoplastic left heart syndrome M/F: 2.6/1; aortic stenosis M/ F:1.95/1; aortic coarctation M/F: 1.3/1).…”

Section: Heart Disease With Shuntmentioning

confidence: 99%

“…No significant sex differences are reported in the frequency of onset of tricuspid artresia, double-chamber right ventricle, congenital obstructions to the mitral apparatus, cor triatriatum or hypertrophic cardiomyopathy. 3,7 Conotruncal defects D-transposition of the great vessels and double outlet right ventricle are more frequently observed in men (M/F 2.2: 1 and 2.7: 1, respectively), whereas Tetralogy of Fallot (TOF), L-transposition of the great vessels and truncus arteriosus are distributed equally between the two sexes. 7…”

Section: Heart Disease With Shuntmentioning

confidence: 99%

Sex differences in congenital heart defects and genetically induced arrhythmias

Mercuro

Bassareo

Mariucci

et al. 2014

Journal of Cardiovascular Medicine

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Sex medicine can be applied to define the effect of male or female sex-associated differences on the prevalence of congenital heart defects (CHDs), on clinical manifestation of the latter, on means of dealing with the defects and facing consequent surgical treatment, as well as on the success of surgery. The widespread use of modern databases has undoubtedly enhanced the possibility of these observations compared to the past, when findings were limited to case series from single cardiology or paediatric heart surgery units. The aim of the present review is to assess all publications present in the literature on sex differences and CHD, placing particular emphasis on both contradictory aspects and less acknowledged issues. Furthermore, a section of the review is devoted to the effect of sex differences on cardiac arrhythmias, particularly the largely genetically predetermined electrophysiological differences observed between men and women.

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“…Sex‐related differences in incidence and outcomes have been documented for ischemic heart disease, stroke, heart failure, valve disease, and pulmonary hypertension . In relation to CHD, sex‐related differences in incidence have been reported for several lesions such as transposition of the great arteries and left‐sided obstructive lesions (more common in males) and atrial septal defects and Ebstein's anomaly (more common in females) …”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26][27] In relation to CHD, sexrelated differences in incidence have been reported for several lesions such as transposition of the great arteries and left-sided obstructive lesions (more common in males) and atrial septal defects and Ebstein's anomaly (more common in females). 28,29 Evidence of sex disparities in outcomes after pediatric cardiac surgery has been conflicting and possibly confounded by the differential incidence and severity of CHD between the sexes. Although studies on the outcomes of specific lesions did not identify any sex disparities, other studies using risk- 19 (previous admissions=2)+b 20 (previous admissions=>2)+b 21 adjustment methodology suggested that female sex was an independent risk factor for postoperative death.…”

Section: Discussionmentioning

confidence: 99%

Age‐Dependent Sex Effects on Outcomes After Pediatric Cardiac Surgery

Kochilas

Vinocur

Menk

2014

JAHA

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BackgroundSex has been linked to differential outcomes for cardiovascular disease in adults. We examined potential sex differences in outcomes after pediatric cardiac surgery.Methods and ResultsWe retrospectively analyzed data from the Pediatric Cardiac Care Consortium (1982–2007) by using logistic regression to evaluate the effects of sex on 30‐day within‐hospital mortality after pediatric (<18 years old) cardiac operations and its interaction with age, risk category, z‐score for weight, and surgical year for the whole cohort. Of 76 312 operations, 55% were in boys. Unadjusted mortality was similar for boys and girls (5.2% versus 5.0%, P=0.313), but boys were more likely to have cardiac surgery as a neonate and to have more complex operations. After adjustment, the overall test of any association between postsurgical mortality and sex was significant (P=0.002), but the overall test of any interaction was not (P=0.503). However, a potential age‐dependent sex effect on postsurgical mortality was observed among infants subjected to high‐risk operations, with girls doing worse during the first 6 months of life.ConclusionsPatient sex has a significant effect on mortality after pediatric cardiac operations, with an increased risk of death in early infancy for girls after high‐risk cardiac operations. This age‐dependent relationship supports a sex‐related biological effect on postoperative cardiovascular stress.

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Gender differences in pediatric cardiac surgery: The cardiologist's perspective

Cited by 23 publications

References 29 publications

Risk factors of sudden death in young adult patients with myelomeningocele

Risk factors of sudden death in young adult patients with myelomeningocele

Sex differences in congenital heart defects and genetically induced arrhythmias

Age‐Dependent Sex Effects on Outcomes After Pediatric Cardiac Surgery

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