Previous studies of patients undergoing coronary artery bypass grafting (CABG) describe, in the majority, an increased rate of early mortality and morbidity among women as compared with men. Retrospective reviews of large observational studies have shown decreased early risk-adjusted mortality and morbidity among patients undergoing off pump CABG (OPCABG) as compared with those placed on cardio-pulmonary bypass (CPB). These studies have not, however, been sufficiently powered to evaluate gender-specific outcomes and furthermore no studies have examined long-term survival after OPCABG vs CPB beyond 12 months.
Puskas and colleagues reviewed 12,812 consecutive patients undergoing CABG (5667 OPCABG, 7145 CPB) between 1997 to 2006 at two centres. Their analysis included statistical adjustment for 40 preoperative risk factors, and examined long-term survival up to 10 years. Overall OPCABG was associated with a 32% lower risk-adjusted mortality benefit, with the greatest benefit seen among women; 52% reduction vs 14% reduction in men. The type of surgery did not alter long-term survival. These findings suggest that female gender remains a risk factor for negative outcome after CABG and that OPCABG may significantly reduce early post-operative gender-based risk.
- Puskas JD, Kilgo, PD, Lattouf OM et al. Off-pump cornary bypass provides reduced mortality and morbidity and equivalent 10-year survival. Ann Thorac Surg 2008;86(4):1139-46.