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Lucia Torracca Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile.

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Presentation on theme: "Lucia Torracca Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile."— Presentation transcript:

1 Lucia Torracca Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano aprile 2010

2 Il bypass aorto-coronarico: più rischioso e meno efficace? Direttore U.O. Cardiochirurgia A.O.U. Ospedali Riuniti Umberto I- G. M. Lancisi- G. Salesi Presidio Monospecialistico G. M. Lancisi Ancona L. Torracca

3 Preoperative risk profile (women versus men) Older Diabetes/Obesity/Hypertension Smaller body surface area Lower hematocrit Congestive heart failure/NYHA class IV IV heparin/nitroglycerin Urgent/emergent operation Higher STS estimated mortality Aldea Ann Thorac Surg 1999 Single center consecutive 1743 pts

4 Gender profiling in CABG Koch JTCVS 2003;126:204415,597 pts Cleveland Clinic

5 Operative mortality 344,913 pts from STS database

6 Operative mortality

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10 Operative risk factors Aldea Ann Thorac Surg 1999

11 Operative risk factors Internal mammary artery use FEMALEvsMALE 64%vs78%OConnor %vs76%Edwards %vs80%Humphries %vs89%Bukkapatnam 2010

12 Outcome 1113 pts followed for 6-8 weeks after CABG

13 Peric V. ICVTS 2010;10:232 QOL before and after CABG

14 Peric V. ICVTS 2010;10:232 QOL before and after CABG

15 Quality of life

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17 Women may benefit of a more aggressive rehabilitation program

18 - 2 groups of patients 261 women and 261 men computer-matched - All pts bilateral IMA graft - Hospital mortality 3,4% vs 3,8% (women vs men)

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22 Gender and off-pump

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24 Female and leg wound complications Paletta Ann Thorac Surg 2000;70:492

25 Endoscopic vein harvesting Yun JCTS 2005;129:496

26 Increase the use of at least one or better two mammary arteries Optimal management of blood glucose level ( mg/dl) Intraop management of anemia (nadir Ht>22 during CPB): reduce pump prime, ultrafiltration

27 Use of off-pump surgery ? Optimization of thyroxine treatment Hormone replacement therapy???

28 Thanks for the attention!


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