Sex differences in coronary artery bypass graft surgery outcomes: a narrative review.
Sex differences in coronary artery bypass graft surgery outcomes: a narrative review.
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DOI：
10.21037/jtd-23-294
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发表时间：
2023-09-28
影响因子：
2.5
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中科院分区：
文献类型：
--
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冠状动脉旁路移植术（CABG）是全球和美国最常见的心脏手术，然而，女性的预后比男性差。我们的目的是研究CABG结果中这种性别差异的可能驱动因素。一个叙述性的回顾，使用当前搜索最新的文献关于这个主题。尽管在该领域取得了进展，但CABG术后结果的性别差异仍然存在，女性的手术死亡率和发病率明显高于男性。对于这些差异，人们提出了几种解释机制。这些因素包括，但不限于，术前因素，如女性冠状动脉疾病的自然病史，年龄较大，以及在进行CABG手术时合并症的发生率较高。术中因素也被提出发挥作用，包括女性冠状动脉尺寸更小，冠状动脉反应性更强，术中血液稀释性贫血的程度，移植的类型和血运重建的完整性。然而，迄今尚未确定明确的病因。CABG术后结果的性别差异仍然存在，尽管提出了许多病因，但主要驱动因素仍不清楚。需要进一步的研究来确定和解决这种差异的根本原因，并且妇女更多地参与心血管和心脏手术试验至关重要。
Coronary artery bypass grafting (CABG) is the most commonly performed cardiac surgery globally and in the United States, however, women have worse outcomes than men. We aim to examine the possible drivers of this sex difference in CABG outcomes. A narrative review using a current search of the most recent literature on this topic. The sex difference in outcomes after CABG has persisted despite advances in the field, with women having well-described worse operative mortality and morbidity than men. Several explanatory mechanisms have been proposed for these differences. These include, but are not limited to, preoperative factors such as the natural history of coronary artery disease in women, older age, and higher prevalence of comorbidities at the time of presentation for CABG surgery. Intraoperative factors have also been proposed to play a role, including the smaller coronary artery size and greater coronary artery reactivity in women, the degree of intraoperative hemodilution anemia, the type of grafting, and the completeness of revascularization. However, no definitive etiology has been identified to date. The sex difference in outcomes after CABG remains present, and despite numerous proposed etiopathologies, the main driver remains unclear. Further research is needed to identify, and address, the root cause of this difference, and greater participation of women in cardiovascular and cardiac surgery trials is crucial.
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DOI：
10.1016/0735-1097(96)00206-9
发表时间：
1996-09-01
影响因子：
24
作者：
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影响因子：
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影响因子：
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