Surgical revascularization in women: Unique intraoperative factors and considerations

The bad news is that CVD is the number one killer of women, and the number of deaths in women has surpassed that in men since 1984. Women do not perceive this threat, and they might present with atypical symptoms, making diagnosis difficult. When compared with men, women are less likely to be referred for invasive testing and less likely to receive proved efficacious medications (β-blockers, aspirin, and thrombolytics). Women are more likely to present at an older age (10 years older), to present with sudden death, and to die from their first myocardial infarction and are more likely to have multiple comorbidities when compared with men. The increased operative mortality noted when women undergo CABG on pump is multifactorial and might be related to patient size, comorbidities, treatment conservatism, and other unknown contributing factors. Fortunately, the good news is that women benefit from surgical revascularization and have similar long-term results when compared with men. There is hope that equivalent short-term outcomes can be achieved with the use of off-pump CABG. Until the reasons for increased operative mortality in women are elucidated, we should remain advocates for public education and awareness and risk factor modification, include more women in research and clinical trials, maintain an aggressive approach for women, and support CABG as a valuable and beneficial treatment option. The Use of the Terms "Sex" and "Gender" When addressing differences between women and men, every effort should be made to use correct terminology. The authors of the Institute of Medicine report entitled "Exploring the biological contributions to human health: Does sex matter?" point out that the interchangeable use of "sex" and "gender" causes confusion in the scientific community. They also note that consistent usage across disciplines would aid in the accurate measurement and reporting of differences between men and women. They offer the following recommendations: 1. In the study of human subjects, the term "sex" should be used as a classification, generally as male or female, according to the reproductive organs and functions that derive from the chromosomal complement. 2. In the study of human subjects, the term "gender" should be used to refer to a person's self-representation as male or female or how that person is responded to by social institutions on the basis of the individual's gender presentation. 3. In most studies of nonhuman animals, the term "sex" should be used. We have attempted to adhere to these recommendations in this editorial to provide consistency and clarity.