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3 . 2021

The use of microsurgical technique and surgical microscope in coronary artery bypass grafting as a strategy for decreasing gender differences in coronary surgery

Abstract

Aim - to evaluate the possibility to decrease gender differences in coronary surgery by usage of microvascular technique and surgical microscope for coronary artery bypass grafting.

Material and methods. 284 patients with coronary artery disease after coronary artery bypass surgery using microvascular technique and surgical microscope were divided into 2 groups: 1 group - males (n=206; 72.5%); 2 group - females (n=78; 27.5%). The propensity-score matching was applied to reduce differences between the groups. 2 groups of 51 patients were obtained after matching.

Results. Before matching women in comparison with men were older [65 (60-69) and 62 (5766) years, respectively, p=0.0002], more often suffered from diabetes mellitus [42.3 and 21.4%, respectively, p=0.0006], impaired renal function (48.7 and 26.2%, respectively, p=0.0006), more often had III-IV class of angina pectoris (79.5 and 44.2% , respectively, p=0.0001), less often had a history of tobacco smoking (20.5 and 41.7%, respectively, p=0.0008), they rarely received bilateral ITA-grafting (7.7 and 29.6%, respectively, p=0.0001); had a comparable frequency of using internal thoracic artery as a shunt (96.2 and 97.1%, respectively, p=0.71), the duration of cardiopulmonary bypass [63 (53-77) and 68 (57-80) min, respectively, p=0.07], time of myocardial ischemia [38 (32-44) and 40 (33-47) min, respectively, p=0.28] and the number of distal anastomoses [3 (3-4) and 3 (3-4), respectively, p=0.48]. No differences were observed between groups after propensity-score matching. There were no differences in the characteristics of the early postoperative period in the groups before matching, with the exception of a higher incidence of acute renal injury in women (p=0.029); after propensity-score matching the results were similar in the groups. In the mid-term follow-up [32 (20-57) months], there were no significant differences in survival for cardiac related mortality, survival for all-cause mortality, freedom from myocardial infarction, freedom from stroke, freedom from repeat revascularization in groups before and after propensity score-matching.

Conclusion. The use of microsurgical techniques and an operating microscope for coronary artery bypass grafting allows obtaining comparable results of operations in men and women and decreasing gender differences in coronary surgery.

Keywords:coronary artery bypass grafting, female, surgical microscope

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Semchenko A.N., Schevchenko A.M., Semchenko A.V., Zaicev I.V., Fateeva Yu.V., Vnukova T.B. The use of microsurgical technique and surgical microscope in coronary artery bypass grafting as a strategy for decreasing gender differences in coronary surgery. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (3): 91-103. DOI: https://doi.org/10.33029/2308-1198-2021-9-3-91-103  (in Russian)

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Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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