Surgical reconstruction of left ventricle after anterior myocardial infarction in both women and men.

BACKGROUND

Differences between men and women in the prevalence and clinical course of coronary artery disease (CAD) have been well documented. There are no data in literature on the differences between males and females in the incidence of post-infarction left ventricular (LV) wall motion abnormalities of akinesia/dyskinesia type and the outcome after surgical LV reconstruction.

AIM: To compare gender-related differences in clinical characteristics, distribution of LV wall motion abnormalities, and outcome after surgical LV reconstruction.

METHODS

Between 1993 and 2000, 3119 patients underwent surgery for CAD in our institution. Coronary artery bypass grafting (CABG) was performed in 3033 patients. Of those, 86 (2.67%) underwent CABG with concomitant surgical ventricular restoration (SVR). Clinical, echocardiographic and procedural data were compared between females and males.

RESULTS

In the SVR group, the percentage of women was significantly higher than in the CABG group (29% vs 18.5%, p=0.05). Obesity, unstable angina and pulmonary oedema were significantly more common in females than in males. The end-diastolic volume and global ejection fraction were lower in women than in men. The ratio of ANV (systolic volume of akinetic/dyskinetic zone of LV) to EDV (diastolic LV volume) was significantly higher in females than in males. Cardiac output, cardiac index and stroke volume were significantly lower in females. Women had significantly higher NYHA class. Because of the greater extent of LVA in women, patch plasty was performed significantly more often in females than in males (p=0.05). Mortality in both genders was similar (4% vs 3%, NS). After the operation, a significant improvement of LV function was found in both groups, but the degree of improvement was higher in women.

CONCLUSIONS

There is male predominance, both in the CABG and SVR groups, however, the proportion of females in the SVR group is significantly greater than in the whole CABG group. LV function is more depressed and NYHA class is higher in females than males. Because the extent of LV akinesia and dyskinesia is greater in females than in males, the circular plasty with patch closure is required more often in women.