Complete arterial revascularization using bilateral internal mammary artery in T-graft technique for multivessel coronary artery disease in on- or off-pump approach: does gender lose its historical impact on clinical outcome?
OBJECTIVES
Higher rates of mortality and morbidity have been reported in women undergoing coronary artery bypass grafting (CABG) compared with men. Different revascularization techniques (on-pump and off-pump) might influence this outcome.


METHODS
We retrospectively analysed 3445 consecutively recruited patients (all comers) undergoing complete arterial CABG (CACABG) at a single centre between January 2000 and December 2012. CACABG was performed in all patients using bilateral skeletonized internal mammary artery in T-graft technique, either on-pump (n = 2216) or off-pump (n = 1229). Early results (30-day) and long-term follow-up data were analysed with respect to gender-specific outcome.


RESULTS
Women were older than men in both groups (P < 0.001), and men had a higher body mass index (on-pump: P < 0.001; off-pump: P = 0.02) compared with women. Men displayed a higher extent of coronary artery disease (P < 0.001) and an overall lower ejection fraction (P < 0.001) when undergoing on-pump CABG. No gender differences were observed for late survival (P = 0.74 vs P = 0.52) in on-pump and off-pump procedures, respectively. Late follow-up revealed a higher rate of FitzGibbon A graft patency in men undergoing the on-pump approach (P = 0.006).


CONCLUSIONS
CACABG using bilateral internal mammary artery in T-graft technique showed excellent early and long-term results. No significant gender-specific differences were observed in both groups undergoing CACABG with respect to 30 days mortality and morbidity as well as late survival. However, late follow-up revealed a higher graft patency in men undergoing the on-pump approach, compared to women.
['Rieß|Friedrich-Christian|FC|', 'Behrendt|Christian-Alexander|CA|', 'Amin|Wagma|W|', 'Heller|Stefan|S|', 'Hansen|Lorenz|L|', 'Winkel|Stephan|S|', 'Stripling|Jan|J|', 'Rieß|Henrik Christian|HC|']
D000368:Aged D001026:Coronary Artery Bypass D047549:Coronary Artery Bypass, Off-Pump D003324:Coronary Artery Disease D005260:Female D006801:Humans D008297:Male D008323:Mammary Arteries D008875:Middle Aged D012189:Retrospective Studies D012737:Sex Factors D016896:Treatment Outcome
Complete arterial revascularization Bilateral internal mammary artery Gender Coronary artery bypass grafting Off-pump surgery On-pump surgery