Coronary Artery Bypass Graft (CABG)
Generally, women undergo fewer bypass grafting procedures than men and are less likely to receive internal mammary artery grafting, multiple arterial conduits, or coronary endarterectomy[10].
When compared to their male counterparts, women who CABG:
are generally older
have more co-morbidities (diabetes, hypertension, peripheral vascular disease)
have more severe anginal symptoms
have a greater likelihood of procedural complications such as new neurological event, heart failure, perioperative infarcts, hemorrhage and death in 30 days of the procedure .
Other concerns in women include:
bone quality in postmenopausal women
the perceived increased risk of sternal wound infection or dehiscence following use of the internal thoracic/mammary artery[2].
Although women tend to have better preservation of left ventricular function and coronary artery health than men, treatment such as CABG is still not as successful in female patients. Studies attribute this to a smaller coronary artery size in women making the CABG procedure more techinically difficult in women compared to men and resulting in higher risk of graft failure.
Accordingly, women have a relatively higher hospital mortality rates after bypass grafting than men[3]. This result has been explained by factors such as the smaller anatomical size of female coronary arteries, which may represent a challenge during surgery and may result in incomplete revascularization at a more advanced stage of the disease[10].
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2. Mickleborough, L.L., Takagi, Y., Maruyama, H., Sun, Z., Mohamed, S., (1995) Is Sex a Factor in Determining Operative Risk for Aortocoronary Bypass Graft Surgery? Circulation, 92 [suppl II], II-80-II-84.
3. Edwards, F.H., Carey, J.S., Grover, F.L., Bero, J.W., Hartz, R.S., (1998) Impact of Gender on Coronary Bypass Operative Mortality. Am Thorac Surg, 66: 125-31.
10. Abramov, D., Tamariz, M.G., Sever, J.Y., Christakis, G.T., Bhatnagar, G., Heenan, A.L., Goldman, B.S., Fremers, S.E., (2000) The Influence of Gender on the Outcome of Coronary Artery Bypass Surgery. The Society of Thoracic Surgeons, 70:800-6.
