Lucia Torracca Tenth International Symposium HEART FAILURE  & Co. CARDIOLOGY SCIENCE UPDATE   FEMALE DOCTORS SPEAKING  ON ...
Il bypass aorto-coronarico: più rischioso e meno efficace?  Direttore U.O. Cardiochirurgia A.O.U. Ospedali Riuniti “Umbert...
Preoperative risk profile (women versus men) <ul><li>Older </li></ul><ul><li>Diabetes/Obesity/Hypertension </li></ul><ul><...
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 mortality
Operative mortality
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...
Outcome 1113 pts followed for 6-8 weeks after CABG
QOL before and after CABG Peric V.  ICVTS 2010;10:232
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% v...
 
 
 
Gender and off-pump
Gender and off-pump
Female and leg wound complications Paletta Ann Thorac Surg 2000;70:492
Endoscopic vein harvesting Yun JCTS 2005;129:496
<ul><li>Increase the use of “at least” one or “better” two mammary arteries </li></ul><ul><li>Optimal management of blood ...
<ul><li>Use of off-pump surgery ? </li></ul><ul><li>Optimization of thyroxine treatment  </li></ul><ul><li>Hormone replace...
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Lucia Torracca Tenth International Symposium

  1. 1. Lucia Torracca Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile 2010
  2. 2. 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
  3. 3. Preoperative risk profile (women versus men) <ul><li>Older </li></ul><ul><li>Diabetes/Obesity/Hypertension </li></ul><ul><li>Smaller body surface area </li></ul><ul><li>Lower hematocrit </li></ul><ul><li>Congestive heart failure/NYHA class IV </li></ul><ul><li>IV heparin/nitroglycerin </li></ul><ul><li>Urgent/emergent operation </li></ul><ul><li>Higher STS estimated mortality </li></ul>Aldea Ann Thorac Surg 1999 Single center consecutive 1743 pts
  4. 4. Gender profiling in CABG Koch JTCVS 2003;126:2044 15,597 pts Cleveland Clinic
  5. 5. Operative mortality 344,913 pts from STS database
  6. 6. Operative mortality
  7. 7. Operative mortality
  8. 8. Operative mortality
  9. 9. Operative mortality
  10. 10. Operative risk factors Aldea Ann Thorac Surg 1999
  11. 11. 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
  12. 12. Outcome 1113 pts followed for 6-8 weeks after CABG
  13. 13. QOL before and after CABG Peric V. ICVTS 2010;10:232
  14. 14. QOL before and after CABG Peric V. ICVTS 2010;10:232
  15. 15. Quality of life
  16. 17. Women may benefit of a more aggressive rehabilitation program
  17. 18. - 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)
  18. 22. Gender and off-pump
  19. 23. Gender and off-pump
  20. 24. Female and leg wound complications Paletta Ann Thorac Surg 2000;70:492
  21. 25. Endoscopic vein harvesting Yun JCTS 2005;129:496
  22. 26. <ul><li>Increase the use of “at least” one or “better” two mammary arteries </li></ul><ul><li>Optimal management of blood glucose level (100-150mg/dl) </li></ul><ul><li>Intraop management of anemia (nadir Ht>22 during CPB): reduce pump prime, ultrafiltration </li></ul>
  23. 27. <ul><li>Use of off-pump surgery ? </li></ul><ul><li>Optimization of thyroxine treatment </li></ul><ul><li>Hormone replacement therapy??? </li></ul>
  24. 28. Thanks for the attention!

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