Does Gender Bias Play A Role in Cardiovascular Surgery in Women? Interview with:

Habib Jabagi B.Sc., M.Sc., M.D. Department of Surgery University of Ottawa , Ottawa

Dr.  Jabagi

Habib Jabagi B.Sc., M.Sc., M.D.
Department of Surgery
University of Ottawa , Ottawa What is the background for this study? What are the main findings

Response: Women with coronary artery disease (CAD) are at a significant disadvantage compared to men, as they do not consistently receive the same intensive treatment. For example, when surgery is done in men, it is more common to use arteries, as opposed to saphenous veins from the leg to complete the bypass graft. Arteries, such as the left internal thoracic artery, appear to have much better long-term patency than veins, which translates into improved outcomes.

The motivation for this study was to see if our centre, which has embraced the use of arteries quite aggressively, has suffered the same gender disparities with respect to the use of multiple arterial revascularization strategies in coronary artery bypass grafting (CABG). What are the main findings?

Response: Analyzing data from 19,557 patients undergoing CABG at the Ottawa Heart Institute (OHI), between January 1990 and March 2015, we used propensity matching to identify pairs of men and women who were perfectly matched for 45 different pre-treatment variables, such that the only variable of difference was their gender. Of the 627 matched pairs, there were no differences in the number of bilateral internal thoracic arteries (31.9% versus 30.1%) or radial arteries used (44.5% versus 44.1%) between men and women during CABG procedures. However, there was a significant difference in the use of a third artery between men and women (10.5% versus 7.3%), suggesting that although our centre is aggressive in treating CAD in women, we still have work to do.

The results of this study suggest that, when adjusted for important clinical risk factors, it is feasible to provide excellent degrees of multiple arterial revascularization in both men and women. The minor gender difference in strategy of using the third artery indicates that bias still plays a role, however the clinical significance of this is not known. What should readers take away from your report?

Response: We hope that readers will understand that gender bias alone is not the reason why women and men receive different surgical treatments for CAD. Rather these decisions may be influenced by a delay in diagnosis of CAD in women, as women tend to present much later in life, with greater risk profiles. For example, female patients are generally older and more frequently afflicted with other diseases such as diabetes, peripheral vascular disease, and obesity. With less physiologic reserve, surgeons may be more reluctant to perform the complex multiple arterial revascularization procedures used in male patients.

The results of this study showed that at our institution, gender did not play a significant role in whether or not woman received bilateral mammary grafts or radial artery grafts. However, this is not necessarily the case in the rest of North America, where the traditional approach of “one artery two veins” remains prevalent. This suggests that there is a lot of room for improvement in many centres. What recommendations do you have for future research as a result of this study?

Response: As data is lacking, some surgeons are not necessarily convinced that women benefit from CABG to the same degree as men. Further, it is not yet clear whether aggressive, more complex operations, such as multiple arterial revascularization, provide additional long-term benefits in women. Therefore, we believe that detailed studies (high quality propensity matched studies of large registries and databases, and targeted randomized clinical trials) are needed in this field, and the results will hopefully address some of these questions. Is there anything else you would like to add?

Response:  Gender disparity in the treatment of cardiovascular disease exists across specialities, and will continue as long as no action is taken. As cardiac surgeons, we are obliged to offer the same level of care to all, and we must therefore work hard to close this gender gap and optimize surgical revascularization for the entire population we serve. Thank you for your contribution to the community.


Impact of Gender on Arterial Revascularization Strategies for Coronary Artery Bypass Grafting
Jabagi, Habib et al.
The Annals of Thoracic Surgery , Volume 0 , Issue 0 ,


Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on October 6, 2017 by Marie Benz MD FAAD