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Gender Related Differences In Coronary Artery Surgery Bypass: Midcab Surgery Can Close The Gap
Marianna Buonocore1, Jef Van den Eynde1, Herbert De Praetere1, Marc Coosemans2, Nick Hiltrop3, Johan Bennet1, Steven Jacobs1, Wouter Oosterlick1.
1KU Leuven, Leuven, Belgium, 2AZ Turnhout, Turnhout, Belgium, 3AZ Groeninge, Kortrijk, Belgium.
Objectives: Gender differences in coronary artery disease in terms of clinical presentation, diagnosis and outcomes after coronary artery bypass surgery are known. We analyzed our experience with minimally invasive direct coronary artery surgery bypass (MIDCAB) to evaluate a possible gender-effect on surgical outcome. Methods: We retrospectively analyzed the data from our internal database of 249 consecutive patients (23% women) who underwent MIDCAB surgery between July 2015 and June 2019 at our institution. Major adverse cardiac and cerebrovascular events (MACCE) were recorded for a median follow up of 416 days. Results: No other major differences at baseline characteristics were found between men and women in our population except for a significantly higher incidence of arterial hypertension in women (74% vs 57% for women and men respectively, p=0.02) Surgical strategy, use of hybrid procedures, single or bilateral mammary arteries, number of anastomoses, surgery time, and intraoperative hemoglobin changes were not significantly different between the two groups. Women experienced an higher incidence of wound complications (7.5% vs 18%, p=0.03). We observed two cases of graft failure that needed percutaneous coronary intervention, both in women (at day 192 and 294 post-operatively) . At 1-year mortality and MACCE were comparable (3.5% and 8.8% in women vs 3.1% and 5.2% in men, p=0.4 and p=0.3 respectively). Conclusions MIDCAB surgery, either isolated or in a hybrid revascularization setting, can safely be performed with comparable good results in both genders. Off-pump surgery, use of arterial grafts and minimal invasive techniques can potentially help to close the gender-gap. Wound healing complications associated with female chest anatomy could potentially benefit from totally endoscopic coronary artery bypass technique. 
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