The evidence about women and heart surgery continues to be bad.
The latest study concludes that women who undergo artery bypass recover more slowly and report less satisfaction with the operation than men who have the procedure.
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Clear gender differences after bypass surgery
That finding, from doctors in Georgia and Connecticut, adds to an already daunting array of material showing clear and substantial gender differences after bypass surgery, which is performed to restore healthy blood flow around blocked vessels.
"Women much more than men are unsatisfied about the whole surgery and recovery process," says Dr Viola Vaccarino, an Emory University heart specialist and collaborator on the research project. "Many women said they would not go through a bypass again if they had known what they know now." Vaccarino presented her findings at a meeting in Atlanta of the American College of Cardiology.
Valuable findings
Dr Mehmet Oz, director of the cardiovascular institute at the Columbia University College of Physicians and Surgeons in New York City, calls the study "valuable."
Oz and his colleagues published a paper in 2000 showing that, among New York patients, the death rate from bypass surgery was about 50 percent higher for women than men. The main reason for the split, he says, is an old engineering saw: When all you have is a hammer, every problem is a nail.
Bypass surgery was pioneered when heart disease was largely considered a male problem, Oz says. But since it's now clear that the biology of the disease is different for men and women, it's unreasonable to expect identical results between genders. "We have always been hammers" when it comes to treating women with obstructed vessels, Oz adds.
Men with hardened arteries typically have calcifications that thicken their vessels, so rerouting blood flow around a clog makes sense. But women are much more likely to have narrowing due to spasm, not build-up. So, diversion is likely to face the same obstacles in other tubes, Oz says. Women also have smaller arteries than men, making surgery more difficult.
"Operating on a woman's arteries is like trying to sew tissue paper," he says.
Younger women at higher risk
In an earlier study, Vaccarino and her colleagues found that women who undergo coronary bypass grafts (also known as CABG, pronounced like the vegetable) have higher near-term death rates after the operation than male patients. That difference is chiefly because of much greater mortality among the youngest patients, particularly those under 50 and to a lesser degree, those aged 50 to 60.
In the latest work, the researchers looked for differences in heart and vessel symptoms, return hospitalisations, depression and other quality-of-life factors in 294 women and 787 men who underwent bypass surgery at Emory and at Yale University.
Six months after the operation, roughly two percent of male and female patients had died. However, Vaccarino says the study was too small to detect a mortality difference, especially among women under 50.
Both men and women reported improvements in their quality of life after surgery. But women seemed to get better more slowly, the researchers found. They had more depression, were more likely to run short of breath - usually a reflection of heart failure - and had more significant physical limitations than men.
After adjusting for differences in age, accompanying illness and other factors that affect prognosis, women were 50 percent more likely than men to be readmitted to the hospital during the study period (30 percent vs. 20 percent), Vaccarino says.
What to do
While women might do worse than men after bypass, Oz says there are other treatments for narrowed arteries. Women tend to do quite well on conservative therapy, which includes regular exercise and a low-fat diet.
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