Sex-specific long-term outcomes after combined valve and coronary artery surgery

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.