Gender-related differences in morbidity and mortality during combined valve and coronary surgery

Ibrahim, Mohamed F.; Paparella, Domenico; Ivanov, Joan; Buchanan, Michael R.; Brister, Stephanie J.

doi:10.1016/s0022-5223(03)00355-6

Cited by 84 publications

(57 citation statements)

References 20 publications

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“…In line with the majority of previous studies, we found distinctive risk profiles for men and women undergoing AVR 4, 6, 11, 12, 17, 27. Women undergoing AVR (isolated or combined) were older and had more nonatherosclerotic comorbid conditions at presentation including hypertension, diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation/flutter, and anemia compared with men.…”

Section: Discussionsupporting

confidence: 92%

“…The outcomes of AVR have improved significantly nationwide in the past decade 3. Several studies have assessed the differential impact of sex on outcomes of AVR but yielded conflicting results 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. The interest in examining the sex gap in AS patients has been renewed with the introduction and widespread adoption of transcatheter AVR (TAVR).…”

Section: Introductionmentioning

confidence: 99%

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Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

Chaker

Badhwar

Alqahtani

et al. 2017

JAHA

141

124

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BackgroundStudies assessing the differential impact of sex on outcomes of aortic valve replacement (AVR) yielded conflicting results. We sought to investigate sex‐related differences in AVR utilization, patient risk profile, and in‐hospital outcomes using the Nationwide Inpatient Sample.Methods and ResultsIn total, 166 809 patients (63% male and 37% female) who underwent AVR between 2003 and 2014 were identified, and 48.5% had a concomitant cardiac surgery procedure. Compared with men, women were older and had more nonatherosclerotic comorbid conditions including hypertension, diabetes mellitus, obstructive pulmonary disease, atrial fibrillation/flutter, and anemia but fewer incidences of coronary and peripheral arterial disease and prior sternotomies. In‐hospital mortality was significantly higher in women (5.6% versus 4%, P<0.001). Propensity matching was performed to assess the impact of sex on the outcomes of isolated AVR and yielded 28 237 matched pairs of male and female participants. In the propensity‐matched groups, in‐hospital mortality was higher in women (3.3% versus 2.9%, P<0.001). Along with vascular complications and blood transfusion (6% versus 5.6%, P=0.027 and 40.4% versus 33.9%, P<0.001, respectively). Rates of stroke, permanent pacemaker implantation, and acute kidney injury requiring dialysis were similar (2.4% versus 2.4%, P=0.99; 6% versus 6.3%, P=0.15; and 1.4% versus 1.3%, P=0.14, respectively). Length of stay median and interquartile range were both similar between groups (7±6 days). Rates of nonhome discharge were higher among women (27.9% versus 19.6%, P<0.001).ConclusionsWomen have worse in‐hospital mortality following AVR compared with men. Coupled with the accumulating evidence suggesting higher magnitude of benefit of transcatheter AVR over AVR in women, women should perhaps be offered transcatheter AVR over AVR at a lower threshold than men.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

Chaker

Badhwar

Alqahtani

et al. 2017

JAHA

141

124

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“…Mortality rates for CABG are documented to be approximately 3% [12,13], although it is well recognized that rates are higher for patients with significant comorbidities and patients receiving valvular or combined procedures [14,15]. Most recent studies have placed the incidence of stroke at about 4% for CABG, more than 7% for CABG/valve operations combined, and nearly 9% for mitral valve procedures [16].…”

Section: Commentmentioning

confidence: 99%

Statin Therapy Improves Outcomes After Valvular Heart Surgery

Fedoruk¹,

Wang

Conaway

et al. 2008

The Annals of Thoracic Surgery

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“…Of 297 treated subjects, 17 discontinued the study for consent withdrawal, 3 death, 5 or being lost to follow up. 9 The patient profiles are reviewed in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Beneficial Effects of Complement Inhibition With Soluble Complement Receptor 1 (TP10) During Cardiac Surgery

Lazar

Keilani²,

Fitzgerald³

et al. 2007

Circulation

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and the TP10 Cardiac Surgery Study GroupBackground-TP10, a potent inhibitor of complement activation during cardiopulmonary bypass (CPB) has been shown to significantly reduce the incidence of death and myocardial infarction (MI) in high-risk male patients undergoing cardiac surgery. However, the effect of TP10 in females was undefined because of the limited number of females studied. To examine the possibility of a gender effect, this phase 2 multi-center trial was undertaken to determine whether TP10 would also limit ischemic damage in a larger sample size of high-risk females undergoing cardiac surgery on cardiopulmonary bypass (CPB). Methods and Results-This prospective, double-blind, placebo-controlled, multi-center trial involved 297 high-risk (urgent surgery, CABG ϩ Valve, reoperations, ejection fraction Ͻ30%) female patients randomized to receive a 5 mg/kg dose of TP10 (nϭ150) or placebo (nϭ147) as a 30-minute intravenous infusion before surgery. The primary end point was the incidence of death or MI at 28 days after surgery. Complement activation was assessed by levels of CH50 and SC5b-9 during and after CPB. TP10 was well tolerated and there were no differences in the safety profiles of the 2 groups. Although TP10 effectively suppressed complement activation (at 2 hours after CPB CH50 (meanϩSD % change from baseline) 50Ϯ17% placebo versus 4Ϯ14% TP10; Pϭ0.0001; SC5b-9 (ng/mL) 917Ϯ1067 placebo versus 204Ϯ79 TP10; Pϭ0.0001), there was no difference in the primary end point between the groups (17% placebo versus 21% TP10; Pϭ0.2550). Conclusions-The benefits of TP10 appear to be gender-related. and mechanisms other than complement activation may be responsible for myocardial injury in high-risk female patients during cardiac surgery on CPB.

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Gender-related differences in morbidity and mortality during combined valve and coronary surgery

Cited by 84 publications

References 20 publications

Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

Statin Therapy Improves Outcomes After Valvular Heart Surgery

Beneficial Effects of Complement Inhibition With Soluble Complement Receptor 1 (TP10) During Cardiac Surgery

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