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Ann Thorac Surg 2006;81:1632-1636
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Sex-Specific Long-Term Outcomes After Combined Valve and Coronary Artery Surgery

^a Division of Cardiovascular Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
^b Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany

Accepted for publication November 28, 2005.

^_* Address correspondence to Dr Brister, Division of Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth St, EN-14-217, Toronto, ON M5G 2C4, Canada (Email: stephanie.brister{at}uhn.on.ca).

BACKGROUND: The purpose of this study is to compare sex-specific, long-term outcomes after combined valve and coronary artery bypass graft surgery (CABG).

METHODS: Between 1990 and 2000, 1,567 patients underwent combined valve and CABG surgery at our institution. Our surgical database was linked to a governmental administrative hospital discharge database and a registry of deaths to obtain long-term follow-up. All patients underwent CABG plus aortic (62%), mitral (31%), or multiple valve surgery (7%).

RESULTS: Women had more preoperative risk factors than men (namely, hypertension, diabetes mellitus, congestive heart failure, atrial fibrillation, and stroke; all p < 0.001). The prevalence of triple-vessel disease was the same between men and women, but women received fewer mammary grafts and fewer total bypass grafts (both p < 0.01). Women received fewer mitral valve repairs and more mitral valve replacements than men (p = 0.014). Length of follow-up was 5.3 ± 3.2 years (mean ± SD; range, 0 to 12.5) and was 99.8% complete. Both sexes had similar long-term survival rates. Women were at higher risk of stroke during follow-up (risk ratio = 1.52, 95% confidence interval: 1.1 to 2.1). There were no sex differences in rehospitalization for acute myocardial infarction (p = 0.9), heart failure (p = 0.4), redo cardiac surgery (p = 0.5), or endocarditis (p = 0.4).

CONCLUSIONS: Women have a higher preoperative risk profile than men undergoing combined valve and CABG surgery, but long-term survival rates are similar. Female sex is an independent predictor of stroke during follow-up. Further studies should focus on the cause of increased risk of stroke and methods of prevention.

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