Lucia Torracca Tenth International Symposium

Lucia Torracca Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile 2010

Il bypass aorto-coronarico: più rischioso e meno efficace? Direttore U.O. Cardiochirurgia A.O.U. Ospedali Riuniti “Umberto I- G. M. Lancisi- G. Salesi” Presidio Monospecialistico “G. M. Lancisi” Ancona L. Torracca

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
Aldea Ann Thorac Surg 1999 Single center consecutive 1743 pts

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

Operative mortality 344,913 pts from STS database

Operative mortality

Operative risk factors Aldea Ann Thorac Surg 1999

Operative risk factors Internal mammary artery use FEMALE vs MALE 64% vs 78% O’Connor 1993 65% vs 76% Edwards 1998 67% vs 80% Humphries 2007 83% vs 89% Bukkapatnam 2010

Outcome 1113 pts followed for 6-8 weeks after CABG

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

Quality of life

Women may benefit of a more aggressive rehabilitation program

- 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)

Gender and off-pump

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

Endoscopic vein harvesting Yun JCTS 2005;129:496

Increase the use of “at least” one or “better” two mammary arteries
Optimal management of blood glucose level (100-150mg/dl)
Intraop management of anemia (nadir Ht>22 during CPB): reduce pump prime, ultrafiltration

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

Thanks for the attention!

Lucia Torracca Tenth International Symposium

by cardiacinfo on Dec 06, 2010

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