HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gabriel S. Aldea Oz M. Shapira Harold L. Lazar Richard J. Shemin Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aldea, G. S. Articles by Shemin, R. J. Search for Related Content PubMed PubMed Citation Articles by Aldea, G. S. Articles by Shemin, R. J.

Ann Thorac Surg 1999;67:1097-1103
© 1999 The Society of Thoracic Surgeons

---

Original Article

Effect of gender on postoperative outcomes and hospital stays after coronary artery bypass grafting

^a Cardiothoracic Surgery, Cardiology, and Public Health, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA

Accepted for publication November 2, 1998.

Address reprints to Dr Aldea, Division of Cardiothoracic Surgery, University of Washington, Box 356310, 1959 NE Pacific St, Seattle, WA 98195

	Abstract

Top Abstract Introduction Patients and methods Results Comment References

 
Background. Compared to men, women undergoing coronary artery bypass grafting appear to have a higher morbidity and mortality, particularly in the perioperative period. This study was designed to answer the questions of whether such differences in clinical outcomes between men and women still exist with improvements in surgical techniques and determine whether it is gender or associated comorbid conditions in women that lead to higher morbidity.

Methods. An analysis of a single center’s contemporary experience (1994 to 1997) of 1,743 consecutive patients undergoing primary coronary artery bypass grafting was performed. Only reoperations were excluded. Data were collected prospectively and presented as mean ± standard deviation (p < 0.05).

Results. Women represented 30.0% of patients. Compared with men, women were older (68.4 versus 63.8 years; p < 0.05), and had more urgent surgical interventions (70.0% versus 56.7%; p < 0.05), a higher incidence of diabetes (42.1% versus 26.7%; p < 0.05), hypertension (82.0% versus 73.9%; p < 0.05), lower body surface area (1.73 ± 0.18 m² versus 2.03 ± 0.19 m²; p < 0.05), and hematocrit (31.7% ± 3.9% versus 36.2% ± 3.9%; p < 0.05). Ejection fraction, incidence of previous myocardial infarction, chronic obstructive pulmonary disease, left main (LM) disease, renal insufficiency, extent of coronary disease, and preoperative intraaortic balloon pump were similar. Women received fewer arterial grafts (91.0% versus 95.5%; p < 0.05) and distal anastomoses (3.31 ± 0.88 versus 3.49 ± 0.94 p < 0.05). Despite these differences, there were no statistical differences in the incidence of postoperative death (1.5% versus 1.0%), myocardial infarction (0.6% versus 0.6%), or cerebrovascular accident/transient ischemic attack (1.1% versus 0.4%) between men and women. Women had a higher inotropic support (10.2% versus 4.4%; p < 0.05) and longer hospital stays (7.3 ± 5.7 days versus 6.3 ± 4.2 days; p < 0.05). Using multivariate analysis, female gender was not an independent predictor of death or postoperative complications but was a predictor of length of hospital stay, use of arterial grafts, and extent of coronary revascularization.

Conclusions. After accounting for differences in their risk variables, the incidences of death, perioperative myocardial infarction and cerebrovascular accident/transient ischemic attack after coronary artery bypass grafting in women and men were not statistically significant. Perioperative complications are related to comorbid risk factors but not to female gender itself. Further studies are warranted.

	Introduction

Top Abstract Introduction Patients and methods Results Comment References

 
Women who undergo coronary artery bypass grafting (CABG) are reported to have higher perioperative mortality and morbidity compared with men [1–15]. Explanations for this observation vary widely, as do assessment of long-term outcomes of revascularization procedures in women. Many investigators have suggested that female gender itself is predictive of poor perioperative results, whereas many other researchers argue that, once comorbid conditions and smaller body surface area (BSA) or body mass index, surrogates for smaller coronary arteries, are taken into account, female gender ceases to be an independent predictor of outcome. Virtually all investigators, however, agree that compared with men, women present at a more acute and symptomatic stage of their disease, and at the time of presentation are older, have a higher incidence of diabetes, hypertension, and congestive heart failure.

The management of women with known or suspected coronary artery disease has recently come under close scrutiny. Increasingly, research aims to differentiate and disassociate possible treatment biases, leading to varied clinical approaches to men and women with coronary artery disease, from clinical outcomes [16, 17]. More specifically, concerns have been raised that both actual differences in clinical outcomes and the perception of worse outcomes in women may lead to delayed treatment and interventions in women with coronary artery disease, leading to increased periprocedural morbidity and accentuating possible differences in clinical outcomes between men and women undergoing CABG [15].

Analyzing the findings of a single center’s contemporary experience of patients undergoing primary CABG with current surgical techniques, this study seeks to disassociate postoperative clinical outcomes specific to female gender from other presenting comorbid risk factors and to address possible concerns of treatment bias.

	Patients and methods

Top Abstract Introduction Patients and methods Results Comment References

 
An analysis of a single center’s contemporary (1994 to 1997), consecutive and unselected experience of 1,743 patients undergoing isolated, primary CABG was performed. Only reoperations were excluded. Data were collected prospectively in all patients undergoing CABG as part of the Society of Thoracic Surgeons (STS) National Cardiac Surgery Database registry.

An integrated blood conservation strategy was developed and uniformly applied to all patients undergoing CABG, regardless of circumstance of surgical intervention (elective, urgent, or emergent). The precise techniques and composition of the cardiopulmonary bypass circuit and specific techniques of myocardial preservation were previously described in detail [18, 19]. Standardized techniques of all aspects of CABG, as well as standardized configuration and components of cardiopulmonary bypass, were adopted including routine use of "tip-to-tip" heparin-bonded cardiopulmonary bypass circuit with either ionic (Duraflo II; Baxter, Irvine, CA) or covalent bound heparin (Carmeda; Medtronic Inc, Minneapolis, MN). Strict protocols delineating thresholds for transfusion, meticulous attention to technical detail, and, finally, a concerted effort by the surgeons, perfusionists, anesthesiologists, and nurses to minimize homologous transfusion were observed. Uniform pathways leading to extubation, intensive care unit, and hospital management pathways and discharge criteria were uniformly applied to all patients throughout the study period.

Society for Thoracic Surgeon’s Database definitions for circumstances for operation (elective, urgent, and emergent) and complications of operation were uniformly adopted. Postoperative myocardial infarction (MI) was defined as either a new Q-wave in two or more leads or new left bundle branch block on postoperative standard 12-lead electrocardiogram [20], or creatine kinase >700 U/L with cardiac index of >2.5 [21], or a new regional wall motion abnormality detected on routine intraoperative transesophageal echocardiography. Postoperative incidence of inotropic requirement was defined as any inotropic drug requirement surpassing dopamine at 5 µg/kg-min to maintain the cardiac index at >2 L/min-m². Renal dysfunction was defined as an increase of creatinine of >1 mg/dL above baseline. Respiratory complications were defined as prolonged ventilator support for >48 hours, pneumonia, adult respiratory distress syndrome, pleural effusion requiring thoracentesis, pulmonary embolism, or tracheostomy. Vascular complications were defined as the occurrence of large groin or retroperitoneal hematoma requiring transfusion, thromboembolism, or pseudoaneurysm. Major vascular complications were defined as those requiring surgical repair. Major complications were defined as Q-wave MI, cerebrovascular accident, and any complication requiring operative reintervention.

Statistical analysis
All summary statistics are presented as mean ± standard deviation for continuous variables and as percentages for categoric variables. Woman were compared to men using a two-sample t test for continuous variables or a ² test for categoric variables. Multivariate linear regression analyses were performed to determine important predictors of a continuous outcome (such as length of hospital stay), whereas logistic regression models were used when the dependent variable (outcome) was dichotomous (such as the occurrence of postoperative complications yes/no). All independent variables that were a priori considered to be important predictors of an outcome and variables that differed between genders, and were considered to be potential confounders of the relationship between gender and the outcome (preoperative risk profiles), were included in the multivariate analyses. A backward elimination procedure, although always including gender in the model, was then used to obtain a more parsimonious model. The results from the reduced models, which include only those variables that remained significant predictors of the outcome, are reported. Note that the interpretation of the relationship between gender and outcome was the same for the full and reduced models for each outcome. Odds ratios resulting from the logistic regression analyses are presented with 95% confidence limits. A model R² value is reported for continuous outcomes and the c-statistic, a measure of rank correlation between observed responses and predicted probabilities, is reported for dichotomous outcomes. Note that the c-statistic ranges from 0.5 to 1 (perfect agreement). Results were considered to be significant at the p value less than 0.05 level.

	Results

Top Abstract Introduction Patients and methods Results Comment References

 
Women comprised 30.0% of all patients undergoing CABG. The preoperative risk profiles differed significantly between men and women undergoing CABG (Table 1 ). Compared with men, women undergoing CABG were older (68.4 ± 10.4 years versus 63.8 ± 10.4 years, p < 0.001), had a higher incidence of diabetes (42.1% versus 26.7%, p < 0.001), obesity (22.1.3% versus 8.9%, p < 0.0001), hypertension (82.0% versus 73.9%, p < 0.001), congestive heart failure (25.6% versus 18.0%, p < 0.001), a higher New York Heart Association functional class (3.55 ± 0.50 versus 3.44 ± 0.50, p = 0.006), and required more nonelective interventions (70.0% versus 56.7%, p < 0.001). Women undergoing CABG had a smaller BSA (1.73 ± 0.19 m² versus 2.03 ± 0.19 m², p < 0.001) and lower preoperative hematocrit (31.7% ± 3.9% versus 36.2% ± 4.3%, p < 0.0001). The incidence of elevated cholesterol, previous renal dysfunction, cerebrovascular accident or transient ischemic attack, previous MI, chronic obstructive pulmonary disease, peripheral vascular disease, and left ventricular ejection fraction were similar for men and women. These comorbid conditions resulted in a higher estimated STS risk-adjusted mortality in women (5.08% versus 3.04%, p = 0.036).

	Comment

Top Abstract Introduction Patients and methods Results Comment References

 
Coronary artery disease is the leading cause of death in women and men [22], yet women are less likely to undergo percutaneous or surgical revascularization procedures [23–25]. Higher complication rates and lower success rates for CABG in women have been reported in previous studies [1–15]. Once higher periprocedural complications in women were accounted for, men and women had similar long-term outcomes [8–12, 23–25]. It was not clear, however, whether differences in clinical outcomes can be attributed to female gender itself, to older surgical techniques, or alternatively to other associated unfavorable clinical characteristics and profiles noted in women. The impact of the perception of less favorable outcomes in women on referral patterns for surgical intervention is also unclear. This study was designed to answer the question of whether 90-day perioperative clinical outcomes differed in men and women undergoing CABG with contemporary techniques and technologies [18, 19], and whether such differences can be specifically attributed to female gender, in a consecutive, unselected group of patients undergoing primary CABG, in a single institution.

Important advantages of a single institutional study are more uniform clinical practices, particularly with regard to the applications of contemporary advanced techniques, strict adherence to guidelines for clinical practices, and more complete and rigorous data collection. The disadvantages of such studies are inadequate sample size to distinguish differences in rare clinical complications between treatment groups. Conclusions demonstrating similar outcomes have to be carefully scrutinized with respect to the size of the study population and the frequency of the outcome evaluated.

As in other reported series, our study also noted that compared with men, women undergoing CABG had a lower BSA and preoperative hematocrit, a higher incidence of diabetes, obesity, hypertension, congestive heart failure, New York Heart Association functional class, and required more nonelective surgical interventions. These associated comorbid conditions in women resulted in a significantly higher risk-adjusted STS Database estimated mortality (5.1% versus 3.0%, p < 0.001).

Possible clinical biases leading to delayed referral of women for surgical intervention were evaluated [23–25]. If such biases impact clinical practice, they might be expected to be further characterized not just by more urgent interventions and older age in women undergoing CABG, but also be associated with a higher incidence of previous MI, resulting in lower ejection fractions and more extensive coronary artery disease at the time of surgical intervention. In this series, compared with men, although women undergoing CABG were older and required more frequent nonelective interventions, a similar incidence of previous MI, left ventricular ejection fraction, and extent of coronary disease were noted. Thus, the higher incidence of urgent intervention is more likely to reflect more acute and unstable presentation in women, rather than possible practice bias referring women for operation later in their clinical course [23, 24]. These finding are supported by several recent studies suggesting that once women present with acute MI or undergo cardiac catheterization, revascularization is performed with equal frequency in women and men and ejection fraction in women is not adversely affected by increased urgency at presentation [15, 24, 25]. The older age and associated comorbid conditions in women suggest that perhaps women are protected from coronary artery disease and need other associated risk factors to lead to an equivalent extent of coronary artery disease seen in men. The low incidence of periprocedural death in men and women in this contemporary series suggests appropriate patient selection and referral for CABG, as well as the applications of contemporary surgical revascularization strategies.

Intraoperative profiles also differed between men and women, with women receiving fewer arterial grafts and less extensive revascularization (fewer bypasses). It was our expectation that with our contemporary surgical techniques that accept the primacy of arterial conduit to the left anterior descending coronary artery and complete revascularization whenever possible [26, 27], these differences would be explained almost entirely by differences in comorbid risk factors in men and women. We thought that the decision to use arterial grafting and the extent of surgical revascularization would be influenced by age, urgency (circumstance) of surgical intervention, presence of diabetes, quality and size of distal vessels, ejection fraction, and other factors that are indirectly linked with gender (covariants), but not by gender itself. Although previous studies report "routine" use of internal mammary grafting in women, its use still fell short of universal and was less frequent than in men [1–15]. The rate of use of internal mammary arteries in women in our series (>90%) is significantly higher than any previously reported rate (60% to 80%) [1–14], including a 65.3% incidence reported by the national STS Database for 1994 to 1996 [15]. Using multivariate analyses (Tables 7 and 8) we were surprised, therefore, to demonstrate that despite this high rate of ITA use and profound differences in risk profiles, female gender itself did directly influence both the extent of coronary artery revascularization as well as the frequency of use of ITA grafting. These differences could not be solely attributed to "technical" difficulties of operating on smaller coronary arteries, since the average time necessary to construct distal anastomosis was the same for men and women. Such differences in extent of revascularization and use of arterial grafting (ITA) may influence both short- and long-term outcomes after CABG. Long-term outcomes in women undergoing percutaneous and surgical interventions remain controversial. More current series demonstrate that although women report more residual pain and angina after revascularization, women are just as likely as men to have relief from angina and are less likely to require subsequent percutaneous or surgical reinterventions, particularly if the ITA was used [10, 12, 14, 23–25]. Because our data indicate that despite differences in comorbid factors (urgent intervention, age, diabetes, obesity) women are not more prone to develop infection after CABG, we believe that more aggressive efforts to afford women complete revascularization with more extensive arterial revascularization, whenever possible, should be made to ensure long-term outcomes equivalent to those in men.

The incidence of periprocedural death for men and women in this series was not statistically significant. Because the BSA of women was smaller than men, a possible effect of multicollinearity between BSA and gender may exist. This was explored recently by the STS database, which did find a higher incidence of death in patients with smaller BSA. However, differences in mortality between women and men were not noted in the smaller BSA subgroup but was only accentuated with higher BSA [15]. By analyzing the effect of gender (using multivariate analysis) with and without the effect of BSA, we were able to isolate the effect of gender alone. Female gender was not an independent predictor of preoperative death.

In this series, the incidence of perioperative death, MI, neurologic complications, atrial fibrillation, and infection were low and not statistically different in men and women. However, women were more likely to require postoperative inotropic or intraaortic balloon pump support, and had prolonged hospital stays, and therefore, a higher cost. Using multivariate analysis, we have demonstrated that female gender was not an independent predictor of death or postoperative complications, suggesting that these outcomes are associated with comorbid conditions, which are more prevalent in women than in men. The incidence and magnitude of allogeneic transfusion was also significantly higher in women undergoing CABG. Along with other investigators [14], we have previously demonstrated that allogeneic transfusion is an important predictor for time to extubation, incidence of postoperative complications, length of hospital stay, and cost [18]. This again underscores the need to maximize cell saving to minimize transfusion in all patients undergoing CABG, but particularly in women, who are more anemic at the time of presentation for CABG, and because of smaller size, may be more prone to hemodilution. We support the recommendation put forward by some investigators that although such techniques have been widely applied to very high risk groups (Jehovah’s Witnesses, reoperative cardiac surgical procedures), their routine application to all women undergoing cardiac procedures is overdue and has yet to be uniformly accepted [14].

This study concludes that with contemporary surgical and perfusion techniques, female gender itself does not pose an independent adverse risk for perioperative mortality or morbidity associated with CABG. Given the associated comorbid conditions in women, future efforts to decrease allogeneic transfusion and the occurrence of postoperative complications are necessary to further improve clinical outcomes. The decision to proceed with surgical revascularization in women with appropriate indications should be made without the unsupported bias of higher morbidity and with expectations of comparable short- and long-term results to those noted in men. Further studies are encouraged to further support these results.

	References

Top Abstract Introduction Patients and methods Results Comment References

 

1. Bolooki H., Vargas A., Green R., et al. Results of direct coronary artery surgery in women. J Thorac Cardiovasc Surg 1975;69:271-277.[Abstract]
2. Loop F.D., Golding L.R., MacMillan J.P., et al. Coronary artery surgery in women compared with men: analysis of risks and long term results. J Am Coll Cardiol 1983;1:383-390.[Abstract]
3. Gardner T.J., Horneffer P.J., Gott V.L., et al. Coronary artery bypass grafting in women. Ann Surg 1985;201:780-784.[Medline]
4. Richardson V.R., Cyrus R.J. Reduced efficacy of coronary artery bypass grafting in women. Ann Thorac Surg 1986;42(suppl 6):16-21.
5. O’Connor G.T., Morton J.R., Diehl M.J., et al. Differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. Circulation 1993;88:2104-2110.[Abstract/Free Full Text]
6. Weintraub W.S., Wegner N.K., Jones E.L., et al. Changing clinical characteristics of coronary artery surgery. Differences between men and women. Circulation 1993;88(suppl 2):79-86.
7. O’Connor N.J., Morton J.R., Birkmeyer J.D., et al. Effect of coronary artery diameter in patients undergoing coronary bypass surgery. Circulation 1996;93:652-655.[Abstract/Free Full Text]
8. Brandrup-Wognsen G., Berggren H., Hartford M., et al. Female sex is associated with increased mortality and morbidity early, but not late, after coronary artery bypass grafting. Eur Heart J 1996;17:1426-1431.[Abstract/Free Full Text]
9. Mickelborough L.L., Takagi Y., Maruyama H., et al. Is sex a factor in determining risk for aortocoronary bypass graft surgery?. Circulation 1996;92(suppl 2):80-84.[Abstract/Free Full Text]
10. Hammar N., Sandberg E., Larsen F.F., et al. Comparison of early and late mortality in men and women after isolated coronary artery bypass surgery in Stockholm, 1980 to 1989. J Am Coll Cardiol 1997;29:659-664.[Abstract]
11. Koch C.G., Higgins T.L., Capdeville M., et al. The risk of coronary artery surgery in women: a matched comparison using preoperative severity of illness scoring. J Cardiovasc Vasc Anesth 1996;10:839-843.[Medline]
12. Risum O., Abdelnoor M., Svennevig J.L., et al. Risk factors for recurrent angina pectoris and non-fatal myocardial infarction after coronary artery bypass surgery. Eur J Cardiothorac Surg 1996;10:173-178.[Abstract]
13. Utley J.R., Wilde E.F., Leyland S.A., et al. Intraoperative blood transfusion is a major risk factors for coronary artery grafting in women. Ann Thorac Surg 1995;60:570-575.[Abstract/Free Full Text]
14. Czajkowski S.M., Terrin M., Lindquist R., et al. Comparison of pre-operative characteristics of men and women undegoing coronary artery bypass grafting (the Post CABG Behavioral Study). Am J Cardiol 1997;79:1017-1024.[Medline]
15. Edwards F.H., Carey J.S., Grover F.L., et al. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg 1998;66:125-131.[Abstract/Free Full Text]
16. Weitzaman S., Cooper L., Chambless L., et al. Gender, racial and geographic differences in performance of cardiac diagnostic and therapeutic procedures for hospitalized acute myocardial infarction in four states. Am J Cardiol 1997;79:722-726.[Medline]
17. Beardmen D., Allman R., McDonald R., et al. Age, race, and gender variation in the utilization of coronary artery surgery and angioplasty in SHEP. SHEP Cooperative Research Group, systolic hypertension in the elderly program. J Am Geriatr Soc 1994;42:1143-1149.[Medline]
18. Aldea G.S., Doursounian M., O’Gara P., et al. Heparin-bonded circuits with reduced anticoagulation protocol in primary CABG: a prospective, randomized study. Ann Thorac Surg 1996;62:410-418.[Abstract/Free Full Text]
19. Aldea G.S., O’Gara P., Shapira O.M., et al. Effect of anticoagulation protocol on outcomes in patients undergoing CABG with heparin-bonded cardiopulmonary bypass circuits. Ann Thorac Surg 1998;65:425-433.[Abstract/Free Full Text]
20. Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary artery bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996;335:217-225.[Abstract/Free Full Text]
21. Greaves S.C., Rutherford J.D., Aranki S.F., et al. Current incidence and determinants of myocardial infarction in coronary artery surgery. Am Heart J 1996;132:572-578.[Medline]
22. Gillum R.F. Trends of acute MI and CHD death in the U.S. J Am Coll Cardiol 1994;23:1273-1277.[Abstract]
23. Bell M.R., Grill D.E., Garrat K.N., et al. Long-term outcomes of women compared with men after successful coronary angioplasty. Circulation 1995;91:2876-2881.[Abstract/Free Full Text]
24. Robertson T., Kennard E.D., Mehta S., et al. Influence of gender in in-hospital clinical and angiographic outcomes and one-year follow-up in the New Approach to Coronary Intervention (NACI) Registry. Am J Cardiol 1997;80:26K-39K.[Medline]
25. Kelsey S.F., James M., Holubkov A.L., et al. Results of PTCA in women. 1985–1986 National Heart, Lung and Blood Institute’s Coronary Artery Registry. Circulation 1993;87:720-727.[Abstract/Free Full Text]
26. Cosgrove D.M., Loop F.D., Lytle B.W., et al. Does mammary artery grafting increase surgical risk?. Circulation 1985;72(suppl 2):170-174.[Abstract/Free Full Text]
27. Kirklin J.W., Naftal D.C., Blackstone E.A., et al. Summary of consensus concerning death and ischemic events after coronary bypass grafting. Circulation 1989;79(suppl 1):81-91.

This article has been cited by other articles:

				S. Siminelakis, A. Kotsanti, M. Siafakas, G. Dimakopoulos, S. Sismanidis, M. Koutentakis, C. Paziouros, and G. Papadopoulos Is there any difference in carotid stenosis between male and female patients undergoing coronary artery bypass grafting? Interactive CardioVascular and Thoracic Surgery, November 1, 2009; 9(5): 823 - 826. [Abstract] [Full Text] [PDF]

				J. D. Puskas, P. D. Kilgo, O. M. Lattouf, V. H. Thourani, W. A. Cooper, T. A. Vassiliades, E. P. Chen, J. D. Vega, and R. A. Guyton Off-Pump Coronary Bypass Provides Reduced Mortality and Morbidity and Equivalent 10-Year Survival Ann. Thorac. Surg., October 1, 2008; 86(4): 1139 - 1146. [Abstract] [Full Text] [PDF]

				M. H Mandegar, M. Marzban, A. H Lebaschi, P. Ghaboussi, A. R. Alamooti, and A. Ardalan Gender Influence on Hospital Mortality after Coronary Artery Bypass Surgery Asian Cardiovasc Thorac Ann, June 1, 2008; 16(3): 231 - 235. [Abstract] [Full Text] [PDF]

				A. Parolari, L. Dainese, M. Naliato, G. Polvani, C. Loardi, M. Trezzi, M. Fusari, C. Beverini, E. Tremoli, P. Biglioli, et al. Do Women Currently Receive the Same Standard of Care in Coronary Artery Bypass Graft Procedures as Men? A Propensity Analysis Ann. Thorac. Surg., March 1, 2008; 85(3): 885 - 890. [Abstract] [Full Text] [PDF]

				M. A. Albert, N. Halevy, and E. M. Antman Preoperative Evaluation for Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 261 - 280. [Full Text]

				J. D. Puskas, F. H. Edwards, P. A. Pappas, S. O'Brien, E. D. Peterson, P. Kilgo, and T. B. Ferguson Jr Off-Pump Techniques Benefit Men and Women and Narrow the Disparity in Mortality After Coronary Bypass Grafting Ann. Thorac. Surg., November 1, 2007; 84(5): 1447 - 1456. [Abstract] [Full Text] [PDF]

				J. D. Puskas, P. D. Kilgo, M. Kutner, S. V. Pusca, O. Lattouf, and R. A. Guyton Off-Pump Techniques Disproportionately Benefit Women and Narrow the Gender Disparity in Outcomes After Coronary Artery Bypass Surgery Circulation, September 11, 2007; 116(11_suppl): I-192 - I-199. [Abstract] [Full Text] [PDF]

				K. H. Humphries, M. Gao, A. Pu, S. Lichtenstein, and C. R. Thompson Significant Improvement in Short-Term Mortality in Women Undergoing Coronary Artery Bypass Surgery (1991 to 2004) J. Am. Coll. Cardiol., April 10, 2007; 49(14): 1552 - 1558. [Abstract] [Full Text] [PDF]

				N. Ad, S. D. Barnett, and A. M. Speir The performance of the EuroSCORE and the Society of Thoracic Surgeons mortality risk score: the gender factor Interactive CardioVascular and Thoracic Surgery, April 1, 2007; 6(2): 192 - 195. [Abstract] [Full Text] [PDF]

				L. Pilote, K. Dasgupta, V. Guru, K. H. Humphries, J. McGrath, C. Norris, D. Rabi, J. Tremblay, A. Alamian, T. Barnett, et al. A comprehensive view of sex-specific issues related to cardiovascular disease Can. Med. Assoc. J., March 13, 2007; 176(6): S1 - S44. [Abstract] [Full Text] [PDF]

				G W Mikhail Coronary revascularisation in women Heart, May 1, 2006; 92(suppl_3): iii19 - iii23. [Abstract] [Full Text] [PDF]

				I. K. Toumpoulis, C. E. Anagnostopoulos, S. K. Balaram, C. K. Rokkas, D. G. Swistel, R. C. Ashton Jr, and J. J. DeRose Jr Assessment of independent predictors for long-term mortality between women and men after coronary artery bypass grafting: Are women different from men? J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 343 - 351. [Abstract] [Full Text] [PDF]

				R. H. Habib, A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Effects of Obesity and Small Body Size on Operative and Long-Term Outcomes of Coronary Artery Bypass Surgery: A Propensity-Matched Analysis Ann. Thorac. Surg., June 1, 2005; 79(6): 1976 - 1986. [Abstract] [Full Text] [PDF]

				F. H. Edwards, V. A. Ferraris, D. M. Shahian, E. Peterson, A. P. Furnary, C. K. Haan, and C. R. Bridges Gender-Specific Practice Guidelines for Coronary Artery Bypass Surgery: Perioperative Management Ann. Thorac. Surg., June 1, 2005; 79(6): 2189 - 2194. [Abstract] [Full Text] [PDF]

				J. Bucerius, J. F. Gummert, T. Walther, M. A. Borger, N. Doll, V. Falk, and F. W. Mohr Impact of Off-Pump Coronary Bypass Grafting on the Prevalence of Adverse Perioperative Outcome in Women Undergoing Coronary Artery Bypass Grafting Surgery Ann. Thorac. Surg., March 1, 2005; 79(3): 807 - 812. [Abstract] [Full Text] [PDF]

				A. A. Fox and N. A. Nussmeier Does Gender Influence the Likelihood or Types of Complications Following Cardiac Surgery? Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2004; 8(4): 283 - 295. [Abstract] [PDF]

				V. Guru, S. E. Fremes, and J. V. Tu Time-related mortality for women after coronary artery bypass graft surgery: A population-based study J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1158 - 1165. [Abstract] [Full Text] [PDF]

				G. Johnston, J. R. Goss, J. A. Malmgren, and J. A. Spertus Health status and social risk correlates of extended length of stay following coronary artery bypass surgery Ann. Thorac. Surg., February 1, 2004; 77(2): 557 - 562. [Abstract] [Full Text] [PDF]

				V. Vaccarino and C. G. Koch Long-term benefits of coronary bypass surgery: Are the gains for women less than for men? J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1707 - 1711. [Full Text] [PDF]

				C. G. Koch, F. Khandwala, N. Nussmeier, and E. H. Blackstone Gender and outcomes after coronary artery bypass grafting: a propensity-matched comparison J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 2032 - 2043. [Abstract] [Full Text] [PDF]

				C. G. Koch, F. Khandwala, N. Nussmeier, and E. H. Blackstone Gender profiling in coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 2044 - 2051. [Abstract] [Full Text] [PDF]

				C. G. Koch, C. M. Mangano, N. Schwann, and V. Vaccarino Is it gender, methodology, or something else? J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 932 - 935. [Full Text] [PDF]

				R. H. Habib, A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: Should current practice be changed? J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1438 - 1450. [Abstract] [Full Text] [PDF]

				T. Athanasiou, S. Al-Ruzzeh, R. D. Stanbridge, R. P. Casula, B. E. Glenville, and M. Amrani Is the female gender an independent predictor of adverse outcome after off-pump coronary artery bypass grafting? Ann. Thorac. Surg., April 1, 2003; 75(4): 1153 - 1160. [Abstract] [Full Text] [PDF]

				M. A. Albert and E. M. Antman Preoperative Evaluation for Cardiac Surgery Card. Surg. Adult, January 1, 2003; 2(2003): 235 - 248. [Full Text]

				N. A. Nussmeier, M. R. Marino, and W. K. Vaughn Hormone replacement therapy is associated with improved survival in women undergoing coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1225 - 1229. [Abstract] [Full Text]

				P. A. Kurlansky, E. A. Traad, D. L. Galbut, S. Singer, M. Zucker, and G. Ebra Coronary bypass surgery in women: a long-term comparative study of quality of life after bilateral internal mammary artery grafting in men and women Ann. Thorac. Surg., November 1, 2002; 74(5): 1517 - 1525. [Abstract] [Full Text] [PDF]

				J. Steuer, P. Blomqvist, F. Granath, B. Rydh, A. Ekbom, U. de Faire, and E. Stahle Hospital readmission after coronary artery bypass grafting: are women doing worse? Ann. Thorac. Surg., May 1, 2002; 73(5): 1380 - 1386. [Abstract] [Full Text] [PDF]

				N. Sadeghi, S. Sadeghi, Z. A. Mood, and A. Karimi Determinants of operative mortality following primary coronary artery bypass surgery Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 187 - 192. [Abstract] [Full Text] [PDF]

				P. A. Kurlansky, E. A. Traad, D. L. Galbut, M. Zucker, and G. Ebra Efficacy of single versus bilateral internal mammary artery grafting in women: a long-term study Ann. Thorac. Surg., June 1, 2001; 71(6): 1949 - 1958. [Abstract] [Full Text] [PDF]

				T. A. Schwann, R. H. Habib, A. Zacharias, G. L. Parenteau, C. J. Riordan, S. J. Durham, and M. Engoren Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation Ann. Thorac. Surg., February 1, 2001; 71(2): 521 - 530. [Abstract] [Full Text] [PDF]

				H. Reinecke, T. Fetsch, N. Roeder, C. Schmid, A. Winter, M. Ribbing, E. Berendes, M. Block, H. H. Scheld, G. Breithardt, et al. Emergency coronary artery bypass grafting after failed coronary angioplasty: what has changed in a decade? Ann. Thorac. Surg., December 1, 2000; 70(6): 1997 - 2003. [Abstract] [Full Text] [PDF]

				V. Vaccarino, J. L. Abramson, E. Veledar, and W. S. Weintraub Sex Differences in Hospital Mortality After Coronary Artery Bypass Surgery: Evidence for a Higher Mortality in Younger Women Circulation, March 12, 2002; 105(10): 1176 - 1181. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gabriel S. Aldea Oz M. Shapira Harold L. Lazar Richard J. Shemin Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aldea, G. S. Articles by Shemin, R. J. Search for Related Content PubMed PubMed Citation Articles by Aldea, G. S. Articles by Shemin, R. J.