Applying the Gender Lens to Risk Factors and Outcome after Adult Cardiac Surgery

Abstract

Background: Applying the gender lens to risk factors and outcome after adult cardiac surgery is of major clinical interest, as the inclusion of sex and gender in research design and analysis may guarantee more comprehensive cardiovascular science and may consecutively result in a more effective surgical treatment as well as cost savings in cardiac surgery. Methods: We have reviewed classical cardiovascular risk factors (diabetes, arterial hypertension, hyperlipidemia, smoking) according to a gender-based approach. Furthermore, we have examined comorbidities such as depression, renal insufficiency, and hormonal influences in regard to gender. Gender-sensitive economic aspects have been evaluated, surgical outcome has been analyzed, and cardiovascular research has been considered from a gender perspective. Results: The influence of typical risk factors and outcome after cardiac surgery has been evaluated from a gender perspective, and the gender-specific distribution of these risk factors is reported on. The named comorbidities are listed. Economic aspects demonstrated a gender gap. Outcome after coronary and valvular surgeries as well as after heart transplantation are displayed in this regard. Results after postoperative use of intra-aortic balloon pump are shown. Gender-related aspects of clinical and biomedical cardiosurgical research are reported. Conclusions: Female gender has become an independent risk factor of survival after the majority of cardiosurgical procedures. Severely impaired left ventricular ejection fraction independently predicts survival in men, whereas age does in females.

Novel cardioprotection strategies for the aged heart: evidence from pre‐clinical studies

“…Clinical studies have shown poor outcomes post cardiac surgery in the older population, particularly for older women and frail older adults . Thus, there is a need to optimize cardioplegia for these populations.…”

“…This ischaemic intolerance is due, at least in part, to age‐dependent changes in Ca 2+ homeostasis that promote intracellular Ca 2+ accumulation during myocardial ischaemia . There is also evidence for sex differences in ischaemia/reperfusion injury with older females appearing to be at greater risk than males . The reasons for this are not fully understood, but it has been suggested this may be due to a protective role of oestrogen that is lost in women after menopause …”

“…11 These observations are compatible with human studies, where older women are more likely to experience poor outcomes from cardiac surgery than older men. 4 Together, this suggests that it is important to include both older males and older females in pre-clinical studies designed to optimize cardioplegic solutions.…”

“…Frailty is associated with old age, and leads to an increased vulnerability to adverse outcomes from stressors including cardiac surgery . While successful cardiac surgery can enhance the quality of life in older adults, poor outcomes are reported, especially in certain groups such as older women and frail older adults of both sexes . This highlights the need to develop novel strategies to improve outcomes of cardiac surgery in all older people.…”

“…6,7 There is also evidence for sex differences in ischaemia/ reperfusion injury with older females appearing to be at greater risk than males. 4,11 The reasons for this are not fully understood, but it has been suggested this may be due to a protective role of oestrogen that is lost in women after menopause. 12 Myocardial protection in cardiac surgery is accomplished by infusing the coronary circulation with chemical arresting agents known as cardioplegic solutions.…”