J Thorac Cardiovasc Surg 2004;128:4-6
© 2004 The American Association for Thoracic Surgery
a Department of Surgery and Pediatrics (Cardiology), University of California, San Francisco, San Francisco, Calif, USA
b Department of Anesthesia, University of California, San Francisco, San Francisco, Calif, USA
Received for publication March 30, 2004; accepted for publication April 6, 2004.
* Address for reprints: Anthony Azakie, MD, CM, Department of Surgery, University of California Medical Center, 505 Parnassus Ave, Room s-549, Box 0118, San Francisco, CA 94143-0118, USA
|The first 20% of the full text of this article appears below.|
|Editorial Note: The gender initiative continues with a discussion of differences between boys and girls with congenital cardiac disease. Differences in the male/female ratio of incidence have been noted for several cardiovascular malformations. And at least one report has found that female gender per se, at a pediatric age preceding major hormonal differences, may be an independent risk factor for cardiac surgical mortality. We continue our editorial series in two months with an issue devoted to gender-related considerations in thoracic surgery.|
Nancy A. Nussmeier, MDTexas Heart Institute
See related editorial on page 7.
Women have worse outcomes after cardiac surgery.1-5 The Society of Thoracic Surgeons National Cardiac Surgery database provides evidence that women undergoing coronary artery bypass grafting have had a significantly higher operative mortality (4.5%) compared with that of men (2.6%; P < .0001).1 Multivariate analysis showed that women had higher mortality rates than equally matched men in low-risk and medium-risk groups. It was only among very high-risk patients that sex was not found to be an independent predictor of adverse outcomes. Not only is postoperative mortality higher in women, but postoperative morbidity and long-term survival are generally less favorable in women compared with men undergoing coronary bypass grafting. Women are more likely to have unfavorable preoperative profiles: they tend to be older and have diabetes, hypertension, moderate obesity, and renal disease.2 Furthermore, women might have smaller coronary arteries and differences in coronary plaque pathophysiology and vascular endothelial function, which might affect surgical technique, midterm patency rates, and overall outcomes. Women are
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