J De Praetere H Jacobs S Coosemans M Hiltrop N Bennet J Oosterlinck W Gender Related Differences In Coronary Artery Surgery Bypass Midcab Surgery Can Close The Gap Introduction ID: 1038095
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1. Buonocore M, Van den Eynde J, De Praetere H, Jacobs S, Coosemans M, Hiltrop N, Bennet J, Oosterlinck W Gender Related Differences In Coronary Artery Surgery Bypass: Midcab Surgery Can Close The Gap
2. IntroductionGender differences in coronary artery disease in terms of clinical presentation, diagnosis and outcomes after coronary artery bypass surgery are known. Across the EU-28, a higher proportion of women (38.4 %) died from diseases of the circulatory system than men (33.1 %) EUROSTAT November 2019Delayed presentation/diagnosis/medical treatment/admissionLess aggressive treatment for women with NSTEMI-ACS CRUSADE trial 25-30% of PCI and cabg /year are performed in womenHigher (unadjusted) in-hospital mortality after PCI/cabg
3. Higher risk-profile :SymptomsAgeRisk factors: obesity, diabetes, hypercholesterolemiaEnhanced platelet reactivity, fibrinogen, estrogensAspirin resistanceHigher inflammation stateAbnormal vaso-reactivity (coronary microangyopathy)Higher periprocedural mortality:Referral biasSmaller coronary arteriesDecreased body sizeComorbid conditionsLess use LIMA and full arterial revascularizationLess use off-pump
4. Aim of the studyWe analyzed our experience with minimally invasive direct coronary artery surgery bypass (MIDCAB) to evaluate a possible gender-effect on surgical outcome.
5. MethodsWe retrospectively analyzed the data from our internal database of 249 consecutive patients (23% women) who underwent MIDCAB surgery between July 2015 and June 2019 at our institution. Major adverse cardiac and cerebrovascular events (MACCE) were recorded for a median follow up of 416 days.
6. Beating heart, off-pump MIDCAB with robotic harvesting and anastomosis under direct visionLAD, Diag, LCxFull arterial CABG and PCI: HCRMIDCAB (LIMA-LAD) + PCI non-LAD vessel(s)Excellent patency of LIMA + fast recovery and low morbidity after PCIRA-MIDCAB
7. Results 1 Male (192, 77%)Female (57, 33%)pAge (y)66±1068±110.24BMI27.5±4.427±6.60.57GFR (ml/min)75.5±1870±200.05Creatinine (mg/dl)1.1±0.41.0±0.40.20LVEF pre-operative55±856±110.61EuroSCORE1.7±1.31.6±1.00.54Dyslipidaemia96%96%0.84Smoke54%49%0.03COPD23%16%0.25Diabetes25%26%0.90Hypertension57%73%0.02Dialysis0.5%0%0.58Peripheral vascular disease20%14%0.30Neurological dysfunction31%20%0.08Previous cardiac surgery1%0%0.44Critical pre-operative state2.6%0%0.22Unstable angina14%18%0.50Recent AMI25%16%0.18Pulmonary Hypertension12%17%0.10Emergency 16%11%0.48Atrial fibrillation10%9%0.72Pre-operative medicationsAspirinPlavixBrilique 87%18%13% 84%25%10% 0.590.250.61
8. Results 2
9. Results 3
10. Results 4Patient 13 vessels diseasePCI+stenting on LAD and RPD. Repeated in-stent stenosis.MIDCAB LIMA-> Diag 1, LAD Day 192: NSTEMI. Occlusion jump anastomosis LIMA->LAD. Stenting Cx. Watchful waiting for LIMA->LAD.Patient 2- 3 vessels diseasePCI+ stenting on LAD, mid-RCx and RPD. Repeated LAD in-stent stenosis Angor with documented LAD in-stent stenosis MIDCAB: LIMA -> distal LAD - Day 180: PCI on RCx Day 269:. Moderate stenosis LIMA->LAD anastomosis. In-stent stenosis on RCx-> PCI+stentDay 294: PCI LIMA->LAD anastomosis
11. ConclusionsMIDCAB surgery, either isolated or in a hybrid revascularization setting, can safely be performed with comparable good results in both genders. Off-pump surgery, use of arterial grafts and minimal invasive techniques can potentially help to close the gender-gap. Wound healing complications associated with female chest anatomy could potentially benefit from totally endoscopic coronary artery bypass technique.