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J Thorac Cardiovasc Surg 2003;126:950-958
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Gender differences in quality of distal vessels: effect on results of coronary artery bypass grafting

^a University of Toronto, Toronto, Ontario, Canada

Received for publication June 24, 2002; revisions received August 27, 2002; accepted for publication September 24, 2002.

^* Address for reprints: Lynda L. Mickleborough, MD, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, USA, M5G 2C4, Canada
lynda.mickleborough{at}uhn.on.ca

OBJECTIVE:: The quality of target vessels may affect gender differences in outcome after coronary artery bypass grafting. This prospective study compares preoperative angiographic assessment of vessel quality with intraoperative visual assessment of size and presence or absence of diffuse disease. The effect of vessel quality on operative mortality and late survival is examined.

METHODS: Data were prospectively collected on 1939 consecutive patients undergoing isolated coronary artery bypass grafting by a single surgeon. Quality of target vessels was assessed preoperatively (angiogram) and intraoperatively by inspection and probe calibration.

RESULTS:: Vessels were poorly visualized in 29% of female patients and 37% of male patients (P = .004), although all but 1.6% of target vessels were grafted. Women were no more likely than men to have small vessels (<1.5 mm) (57% vs 59%, P = .449) and were less likely to have distal disease (45% vs 53%, P = .005). Operative mortality was low, not statistically different in women versus men (1.3% vs 0.7%, P = .237), and increased in patients with distal disease (1.3% vs .03%, P = .021). Late survival was decreased in patients with poor left ventricle function, congestive heart failure, and peripheral vascular disease. Late survival was decreased in men with increased age, class IV symptoms, small size, and no left internal thoracic artery graft, and in women with recent myocardial infarction and preoperative cerebrovascular accident.

CONCLUSION: We conclude that in most patients with poorly visualized vessels in the preoperative angiogram, complete revascularization can be achieved if one is willing to graft small or diffusely diseased vessels. Women are no more likely than men to have vessels less than 1.5 mm in size and are less likely to have diffuse disease. Such an approach is associated with a low operative mortality and good long-term survival. Predictors of late survival were different for men and women. Neither small vessel size nor diffuse disease was an independent predictors of poor late outcome.

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