Female cardiac surgeons are calling on colleagues to urgently address significant disparities in outcomes for female patients who have undergone coronary artery bypass graft (CABG) surgery.
Their message was shared at the annual meeting of the European Association for Cardio-Thoracic Surgery (EACTS).
Dr Rashmi Yadav, MBBS, PhD, consultant cardiac surgeon at the Royal Brompton Hospitals in London, stressed that women cannot be treated as mere variations of men regarding cardiovascular surgery, stating ‘women are not simply small men’.
‘Women are more likely to die, more likely to have worse outcomes, and more likely to have an infection compared with men in coronary surgery,’ she said.
Overwhelming evidence shows that women face higher mortality rates, more adverse outcomes, and increased susceptibility to infections following coronary surgery.
Drawing from recent Lancet Commission findings dedicated to reducing the global burden of cardiovascular disease in women, Dr Yadav pointed out that it is the cause of 35% of all female deaths.
Quoting the commission, she reminded the audience that cardiovascular disease remains ‘understudied, under-recognised, underdiagnosed, undertreated and women are underrepresented in clinical trials’.
Women’s participation in clinical trials has decreased over the years, creating a substantial gap in the understanding of cardiovascular disease in women.
Dr Yadav stressed that research is the cornerstone for improving outcomes in female coronary surgery.
A significant step towards addressing this knowledge gap is the ROMA-Women trial, led by Dr Mario Gaudino, MD, PhD, of Weill Cornell Medicine in New York. This ground-breaking study, part of the larger ROMA trial, is striving to shed light on the optimal surgical approach for women, who make up around 15% of participants in the trial.
The pace of enrolment in the ROMA-Women trial has exceeded expectations, thanks to the support of the Global Cardiovascular Research Funding Forum.
Dr Sigrid Sander, MD, from the Medical University of Vienna, Austria, painted a sobering picture of the disparities in outcomes between women and men undergoing CABG surgery. These disparities begin from the moment of diagnosis, with women typically receiving referrals for surgery at later stages, often burdened with more comorbidities.
Moreover, women are less likely to receive guideline-recommended revascularisation techniques and postoperative care, resulting in worse clinical outcomes.
Studies confirm that women face higher risks of graft failure, readmissions, and adverse events post-surgery. Dr Sander highlighted the necessity for tailored surgical approaches and care strategies for women, particularly those with complex coronary anatomy.
The heart of the issue lies in the anatomic and physiological differences between women and men. Female patients possess smaller coronary arteries, narrower sternums and unique anatomical challenges, making surgery technically demanding.
These differences contribute to the heightened risk of complications, including sternal wound infections.
Dr Yadav proposed the idea of specialised cardiac surgeons dedicated to treating female CABG patients, emphasising the need for meticulous attention to detail in their care.
She also pointed out that empathy and communication play a significant role in patient outcomes, with women particularly sensitive to a surgeon’s bedside manner.
Dr Jennifer Lawton, MD, from Johns Hopkins Medicine, underscored that while waiting for the results from ROMA and ROMA-Women, surgeons can take proactive steps to optimise outcomes for female patients.
Data supports using multi-arterial grafting in women to enhance survival and reduce major cardiac and cerebrovascular events (MACCE). Thus, there are measures surgeons can implement to improve female patients’ prospects.
