Coronary artery bypass grafting in women--is OPCAB mandatory?

OBJECTIVE: There has been an explosive increase in our understanding of the natural history and progression of CAD in women. Women have a poorer prognosis and a more severe outcome than men after myocardial infarction, Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG). The purpose of the present study was to evaluate the differences in the results of CABG in women as compared with men using Pump and Off Pump operating techniques.

METHODS: Data of 3500 patients undergoing coronary artery bypass grafting by a single surgeon at two institutes over an 8-year period were analyzed. Clinical data including demographic and risk profile and perioperative data were obtained from case records, operation notes, ICU charts and out-patient records. Data were analyzed using 'chi square' test to calculate p value for various parameters.

RESULTS: 14.6% of patients were women. Coronary artery size correlated with body surface area (BSA) but even with BSA > 1.5m2, it was smaller than the males. Inhospital mortality was higher in women as compared to men, being 2.92% versus 1.8% in men. The ventilation time, blood requirement, ICU stay, inotropic requirement and hospital stay were identical with results seen in men in our series. The commonest causes of mortality were low cardiac output and renal failure. Use of Off Pump technique reduces mortality (1.84% Vs 4.5% on Pump--p = 0.01) in women, besides reducing the blood requirement (2.5 +/- 1.2 units/pt in OPCAB Vs 4.3 +/- 1.4 units/pt in Pump group--p < 0.001; ICU stay (29.4 +/- 16.4 hrs Vs 38.3 +/- 17.3 hrs in Pump group--p < 0.0001); & hospital stay (6.81 +/- 1.6 days Vs 8.05 +/- 2.1 days in pump group--p < 0.0001). However, there was no statistically significant difference in the rates of mediastinitis, Arrhythmias, Neurological or Pulmonary complications between the OPCAB & Pump group.

CONCLUSIONS: Women coming for coronary artery bypass surgery are a special risk group. The operative and early mortality of bypass surgery in women is higher than in men for conventional CABG. However, off pump techniques has negated this to a large extent. Our findings lead us to conclude that use of OPCAB promises to be gratifying enough to mitigate the early concerns in this group of patients.