Coronary artery bypass grafting (CABG) surgery is a major operation that uses arteries or veins from the body to reroute blood around a blockage in the coronary arteries (the arteries that supply blood and oxygen to the heart).

Fewer women than men undergo CABG, and CABG research — along with other heart research — has focused on male patients for many years. However, there have now been a number of studies on how women fare after bypass surgery.

Studies show an increased hospital death rate after CABG in women compared with men.1-3 This difference is more pronounced in younger women (particularly in women under 50 and in the 50-59 age group)4 and has been attributed to such factors as how doctors refer women and men for treatment, smaller vessels in women, and decreased body size and more additional medical conditions in women.5-8  At the same time, studies show that women still derive the same long-term benefits from CABG as men.8,9

Improving CABG outcome in women

Although debate continues on why women have a higher early death rate after CABG than men, several surgical techniques may improve outcomes for women having the procedure.

A variation of CABG surgery called off-pump coronary artery bypass (OPCAB) has been shown to reduce death rates in women and to yield rates equivalent to those of men.10,11 OPCAB makes heart surgery less invasive because the patient is not placed on cardiopulmonary bypass. OPCAB is performed on a beating heart with the use of stabilizers that stabilize the artery being bypassed.

This procedure differs from conventional bypass surgery, in which patients are placed on cardiopulmonary bypass, which includes rerouting the blood outside the body and stopping the heart during surgery. By avoiding cardiopulmonary bypass, the risk of stroke and pulmonary complications may be reduced. Other important advantages of OPCAB may include reduced need for blood transfusions, less heart muscle injury, shorter hospital stay, and reduced stroke risk.

As in conventional bypass surgery, the surgeon uses a sternotomy (mid-chest incision) to access the heart. Although patients are discharged sooner with OPCAB, the four-to-six week healing time from the sternotomy is similar to the conventional procedure.

Along with OPCAB, the selection of certain types of grafts for a CABG procedure may benefit female patients. Using the left internal mammary artery for the bypass graft has been shown to prolong survival, but it has been used infrequently in women in the past.12,13   In addition, a smaller percentage of women than men have been demonstrated to receive a radial arterial graft for bypass. In a study conducted at Washington University School of Medicine and Barnes-Jewish Hospital, the five–year survival rate was significantly better for 294 women who received the radial artery graft than for those who did not have a radial artery as a bypass graft.14 The use of the left internal mammary artery and radial artery for bypass grafts in women is vital because these grafts tend to remain open or unobstructed over a longer period of time compared to vein grafts from the leg.12,14

Long-term results of CABG in women

Studies have shown that although women have higher early mortality, they have long-term results similar to men. A study of 54,425 patients (12,079 women) who underwent CABG in the Canadian province of Ontario found that the long-term death risk for women appeared equal to or even better than that of men as early as one year after CABG.15 Another study of 2,000 patients (381 women) in Western Sweden reported that women had a higher risk of in-hospital death and death associated with stroke; however, the adjusted risk of death during 5 years was equal in women and men.16 Finally, a multi-center study in the United States and Canada that followed more than 1,800 patients who underwent CABG or percutaneous transluminal coronary angioplasty (PTCA) found that women and men had a similar 5-year mortality.17

Washington University heart surgeons who perform OPCAB or specialize in treating women with heart disease

Washington University heart surgeon Ralph Damiano Jr., MD, performs the OPCAB procedure in women and men.

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