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Lucia Torracca

Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile 2010. Lucia Torracca. Il bypass aorto-coronarico : più rischioso e meno efficace ?. L. Torracca. Direttore U.O. Cardiochirurgia

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Lucia Torracca

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  1. Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile 2010 Lucia Torracca

  2. Il bypass aorto-coronarico: piùrischioso e menoefficace? L. Torracca Direttore U.O. Cardiochirurgia A.O.U. OspedaliRiuniti “Umberto I- G. M. Lancisi- G. Salesi” Presidio Monospecialistico “G. M. Lancisi” Ancona

  3. Preoperative risk profile(women versus men) • Older • Diabetes/Obesity/Hypertension • Smaller body surface area • Lower hematocrit • Congestive heart failure/NYHA class IV • IV heparin/nitroglycerin • Urgent/emergent operation • Higher STS estimated mortality Single center consecutive 1743 pts Aldea Ann Thorac Surg 1999

  4. Gender profiling in CABG 15,597 pts Cleveland Clinic Koch JTCVS 2003;126:2044

  5. Operative mortality 344,913 pts from STS database

  6. Operative mortality

  7. Operative mortality

  8. Operative mortality

  9. Operative mortality

  10. Operative risk factors Aldea Ann Thorac Surg 1999

  11. Operative risk factorsInternal mammary artery use

  12. Outcome 1113 pts followed for 6-8 weeks after CABG

  13. QOL before and after CABG Peric V. ICVTS 2010;10:232

  14. QOL before and after CABG Peric V. ICVTS 2010;10:232

  15. Quality of life

  16. Women may benefit of a more aggressive rehabilitation program

  17. - 2 groups of patients 261 women and 261 men “computer-matched” • - All pts bilateral IMA graft • - Hospital mortality 3,4% vs 3,8% (women vs men)

  18. Gender and off-pump

  19. Gender and off-pump

  20. Female and leg wound complications Paletta Ann Thorac Surg 2000;70:492

  21. Endoscopic vein harvesting Yun JCTS 2005;129:496

  22. Increase the use of “at least” one or “better” two mammary arteries • Optimal management of blood glucose level (100-150mg/dl) • Intraop management of anemia (nadir Ht>22 during CPB): reduce pump prime, ultrafiltration

  23. Use of off-pump surgery ? • Optimization of thyroxine treatment • Hormone replacement therapy???

  24. Thanks for the attention!

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