Influence of Gender on Postoperative Outcome after Intra-aortic Balloon Counter-Pulsation and Cardiac Surgery

Abstract

Introduction Female gender is an established risk factor for worse outcomes after cardiac surgery, and women are more likely to experience postoperative complications. Our aim was to analyze the influence of gender on outcome and postoperative complications after the use of intra-aortic balloon counter-pulsation (IABP) in cardiac surgery patients.

Methods Fifty-seven consecutive female patients (mean age: 73 ± 9 years) requiring an IABP at our department from January 2007 to January 2010 were retrospectively analyzed and compared with 182 male patients receiving IABP support within the same period. The collected data included patient demographics, preoperative state, operative details, postoperative pharmacological treatment, IABP-associated complications, and inhospital mortality. Preoperative mortality risk was calculated by logistic EuroSCORE.

Results There were no differences regarding the type of operation, preoperative renal or hepatic failure, though the prevalence of peripheral artery occlusive disease was higher in men. Furthermore, female patients receiving an IABP were significantly older (73 ± 9 vs. 67 ± 10 years), had a higher ejection fraction (EF) (45% ± 24% vs. 36% ± 14%), and had a higher EuroSCORE (25% ± 20% vs. 19% ± 17%; p < 0.05). Postoperative catecholamine support was significantly higher in the female patients. Women had a prolonged length of stay (LOS) at the ICU (10.64 ± 9.7 vs. 7.6 ± 7.6 days), higher incidence of renal replacement therapy, and a higher mortality (19 [19.4%] vs. 35 [33.9%]; p < 0.05) after the use of IABP.

Conclusion Women have a worse outcome after the use of IABP, including LOS at the ICU, postoperative renal failure, and inhospital mortality, despite higher EF, when compared with men.

Keywords

surgery - complications - shock - outcomes - intensive care

• References

• 1 Wenger NK. Is what's good for the gander good for the goose?. J Thorac Cardiovasc Surg 2003; 126 (4) 929-931
• 2 Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RS. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg 1998; 66 (1) 125-131
• 3 Woods SE, Noble G, Smith JM, Hasselfeld K. The influence of gender in patients undergoing coronary artery bypass graft surgery: an eight-year prospective hospitalized cohort study. J Am Coll Surg 2003; 196 (3) 428-434
• 4 Alam M, Lee VV, Elayda MA , et al. Association of gender with morbidity and mortality after isolated coronary artery bypass grafting. A propensity score matched analysis. Int J Cardiol 2012; [Epub ahead of print]
• 5 Emmert MY, Salzberg SP, Seifert B , et al. Despite modern off-pump coronary artery bypass grafting women fare worse than men. Interact Cardiovasc Thorac Surg 2010; 10 (5) 737-741
• 6 Aldea GS, Gaudiani JM, Shapira OM , et al. Effect of gender on postoperative outcomes and hospital stays after coronary artery bypass grafting. Ann Thorac Surg 1999; 67 (4) 1097-1103
• 7 Guru V, Fremes SE, Austin PC, Blackstone EH, Tu JV. Gender differences in outcomes after hospital discharge from coronary artery bypass grafting. Circulation 2006; 113 (4) 507-516
• 8 Mannacio V, Di Tommaso L, De Amicis V, Stassano P, Musumeci F, Vosa C. Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization. Ann Thorac Surg 2012; 93 (3) 804-809
• 9 Bahekar A, Singh M, Singh S , et al. Cardiovascular outcomes using intra-aortic balloon pump in high-risk acute myocardial infarction with or without cardiogenic shock: a meta-analysis. J Cardiovasc Pharmacol Ther 2012; 17 (1) 44-56
• 10 Severi L, Vaccaro P, Covotta M, Landoni G, Lembo R, Menichetti A. Severe intra-aortic balloon pump complications: a single-center 12-year experience. J Cardiothorac Vasc Anesth 2012; 26 (4) 604-607
• 11 Kher A, Wang M, Tsai BM , et al. Sex differences in the myocardial inflammatory response to acute injury. Shock 2005; 23 (1) 1-10
• 12 Rastan AJ, Tillmann E, Subramanian S , et al. Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation 2010; 122 (Suppl. 11) S92-S99
• 13 Hauer D, Kilger E, Kaufmann I , et al. Risk and outcome analysis of renal replacement therapies in patients after cardiac surgery with pre-operatively normal renal function. Anaesthesia 2009; 64 (6) 615-619
• 14 Miceli A, Duggan SMJ, Capoun R, Romeo F, Caputo M, Angelini GD. A clinical score to predict the need for intraaortic balloon pump in patients undergoing coronary artery bypass grafting. Ann Thorac Surg 2010; 90 (2) 522-526
• 15 Parissis H, Soo A, Al-Alao B. Intra-aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump. J Cardiothorac Surg 2011; 6: 147