DEPENDENCE OF SURGICAL OUTCOMES IN ASCENDING AORTIC ANEURYSMS ON THE COMPLETENESS OF REVASCULARIZATION WITH REGARD TO GENDER

Abstract

Background. Ascending aortic aneurysms combined with coronary artery disease (CAD) represent a high-risk patient population. Recent studies suggest poorer outcomes in women and a potential impact of incomplete revascularization on postoperative results. However, gender-related aspects of combined surgery for ascending aortic aneurysm repair and coronary artery bypass grafting (CABG) remain insufficiently investigated, warranting comprehensive analysis with regard to sex and completeness of revascularization. Purpose – to evaluate surgical outcomes of ascending aortic aneurysm repair depending on the completeness of myocardial revascularization and gender. Materials and Methods. A total of 341 patients with aortic aneurysms and CAD were included. Patients were stratified by sex: the main group comprised 241 patients who underwent combined or staged aortic and coronary surgery, and the comparison group included 100 patients with aortic aneurysms without CAD. The present analysis included 46 patients who underwent ascending aortic aneurysm repair with CABG: 23 (50.0%) women and 23 men; patients with aortic dissection were excluded. Women had a higher BMI (30.7±6.1 vs 28.2±4.7) and slightly larger ascending aortic diameter (56.8±10.8 mm vs 54.4±12.6 mm), but shorter hospital stay (26.0±10.2 vs 29.0±10.2 days). Results. Operative time, cardiopulmonary bypass duration, and blood loss did not differ between groups (p>0.05), with a trend toward longer aortic cross-clamp time in men (p=0.052). In women, revascularization of 1–2 coronary arteries predominated (43.5% each); three distal anastomoses were performed in 13.0%, and internal mammary artery grafting was not used. In men, two-vessel revascularization was most common (47.8%), and internal mammary artery grafting was performed in 4.3%. Revascularization of the left anterior descending artery was performed in 69.6% of women and 73.9% of men (p=0.011). The circumflex artery was revascularized in 21.7% of women and 34.8% of men (p=0.0001), and the right coronary artery in 39.1% and 47.8%, respectively (p=0.0001). The overall extent of revascularization did not significantly depend on sex: CABG-1 (43.5% vs 30.4%), CABG-2 (43.5% vs 47.8%), CABG-3 (13.0% in both groups), and CABG-4 (0% vs 8.7%) showed no significant differences (p≥0.05). Conclusions. However, qualitative analysis demonstrated gender-related differences in the distribution of coronary involvement, suggesting potential anatomical and functional sex-specific features of the coronary bed.