lucia torracca tenth international symposium
DESCRIPTION
TRANSCRIPT
![Page 1: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/1.jpg)
Lucia Torracca
Tenth International Symposium
HEART FAILURE & Co.CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING
ON FEMALE DISEASES
Milano9 - 10 aprile 2010
![Page 2: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/2.jpg)
Il bypass aorto-coronarico:Il bypass aorto-coronarico:
più rischioso e meno efficace? più rischioso e meno efficace?
Direttore U.O. CardiochirurgiaDirettore U.O. Cardiochirurgia
A.O.U. Ospedali Riuniti “Umberto I- G. M. Lancisi- G. Salesi”A.O.U. Ospedali Riuniti “Umberto I- G. M. Lancisi- G. Salesi”
Presidio Monospecialistico “G. M. Lancisi”Presidio Monospecialistico “G. M. Lancisi”
AnconaAncona
L. TorraccaL. Torracca
![Page 3: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/3.jpg)
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
Aldea Ann Thorac Surg 1999Single center consecutive 1743 pts
![Page 4: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/4.jpg)
Gender profiling in CABG
Koch JTCVS 2003;126:204415,597 pts Cleveland Clinic
![Page 5: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/5.jpg)
Operative mortalityOperative mortality
344,913 pts from STS database
![Page 6: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/6.jpg)
Operative mortalityOperative mortality
![Page 7: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/7.jpg)
Operative mortalityOperative mortality
![Page 8: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/8.jpg)
Operative mortalityOperative mortality
![Page 9: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/9.jpg)
Operative mortalityOperative mortality
![Page 10: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/10.jpg)
Operative risk factorsOperative risk factors
Aldea Ann Thorac Surg 1999
![Page 11: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/11.jpg)
Operative risk factorsOperative risk factors
Internal mammary artery useInternal mammary artery use
FEMALE vs MALE
64% vs 78% O’Connor 1993
65% vs 76% Edwards 1998
67% vs 80% Humphries 2007
83% vs 89% Bukkapatnam 2010
![Page 12: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/12.jpg)
OutcomeOutcome
1113 pts followed for 6-8 weeks after CABG
![Page 13: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/13.jpg)
Peric V. ICVTS 2010;10:232
QOL before and after CABG
![Page 14: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/14.jpg)
Peric V. ICVTS 2010;10:232
QOL before and after CABG
![Page 15: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/15.jpg)
Quality of lifeQuality of life
![Page 16: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/16.jpg)
![Page 17: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/17.jpg)
Women may benefit of a more aggressive rehabilitation program
![Page 18: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/18.jpg)
- 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)
![Page 19: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/19.jpg)
![Page 20: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/20.jpg)
![Page 21: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/21.jpg)
![Page 22: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/22.jpg)
Gender and off-pumpGender and off-pump
![Page 23: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/23.jpg)
Gender and off-pumpGender and off-pump
![Page 24: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/24.jpg)
Female and leg wound complicationsFemale and leg wound complications
Paletta Ann Thorac Surg 2000;70:492
![Page 25: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/25.jpg)
Endoscopic vein harvesting
Yun JCTS 2005;129:496
![Page 26: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/26.jpg)
• 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
![Page 27: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/27.jpg)
• Use of off-pump surgery ?
• Optimization of thyroxine treatment
• Hormone replacement therapy???
![Page 28: Lucia Torracca Tenth International Symposium](https://reader033.vdocuments.us/reader033/viewer/2022061214/549a206eb479595b698b4676/html5/thumbnails/28.jpg)
Thanks for the attention!Thanks for the attention!