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J Thorac Cardiovasc Surg 2004;128:4-6
© 2004 The American Association for Thoracic Surgery

Editorial

Gender differences in pediatric cardiac surgery: The surgeon's perspective

^a Department of Surgery and Pediatrics (Cardiology), University of California, San Francisco, San Francisco, Calif, USA
^b Department of Anesthesia, University of California, San Francisco, San Francisco, Calif, USA

Received for publication March 30, 2004; accepted for publication April 6, 2004.

^* Address for reprints: Anthony Azakie, MD, CM, Department of Surgery, University of California Medical Center, 505 Parnassus Ave, Room s-549, Box 0118, San Francisco, CA 94143-0118, USA
azakiet@surgery.ucsf.edu

The first 20% of the full text of this article appears below.

Editorial Note: The gender initiative continues with a discussion of differences between boys and girls with congenital cardiac disease. Differences in the male/female ratio of incidence have been noted for several cardiovascular malformations. And at least one report has found that female gender per se, at a pediatric age preceding major hormonal differences, may be an independent risk factor for cardiac surgical mortality. We continue our editorial series in two months with an issue devoted to gender-related considerations in thoracic surgery. Nancy A. Nussmeier, MDTexas Heart Institute See related editorial on page 7.

 

Women have worse outcomes after cardiac surgery.^1-5 The Society of Thoracic Surgeons National Cardiac Surgery database provides evidence that women undergoing coronary artery bypass grafting have had a significantly higher operative mortality (4.5%) compared with that of men (2.6%; P < .0001).¹ Multivariate analysis showed that women had higher mortality rates than equally matched men in low-risk and medium-risk groups. It was only among very high-risk patients that sex was not found to be an independent predictor of adverse outcomes. Not only is postoperative mortality higher in women, but postoperative morbidity and long-term survival are generally less favorable in women compared with men undergoing coronary bypass grafting. Women are more likely to have unfavorable preoperative profiles: they tend to be older and have diabetes, hypertension, moderate obesity, and renal disease.² Furthermore, women might have smaller coronary arteries and differences in coronary plaque pathophysiology and vascular endothelial function, which might affect surgical technique, midterm patency rates, and overall outcomes. Women are . . . [Full Text of this Article]