Last Thanksgiving, Cynthia Mosson stood in her Frankfort, Indiana kitchen all day preparing dinner for nine people. She baked the ham in the oven, made the dressing, and was almost done when she suddenly felt like sitting down.
“My left shoulder started to hurt,” said Mosson, 61. “The pain got worse and started going down my left arm.” She was sweaty and pale and told her family, “I think she’s having a heart attack.”
An ambulance took her to the hospital, where doctors confirmed she had suffered a mild heart attack. Mosson recalled that her tests revealed severe blockages in all of her coronary arteries and that she was told that she would “need open-heart surgery.”
CABG (pronounced like vegetable) restores blood flow by harvesting arteries from a patient’s arm or chest and veins from their legs and using them to bypass blocked blood vessels.
“This is the most common heart surgery in the United States,” performed 200,000 to 300,000 times a year, said Dr. Mario Gaudino, a cardiothoracic surgeon at Weill Cornell Medicine and lead author of the study. Stated.
Between 25 and 30 percent of CABG patients are women. how do they do it? Dr. Gaudino and his colleagues found that although the mortality rate from CABG is low, it is much higher in women (2.8%) than in men (1.7%).
Researchers analyzed the results of approximately 1.3 million patients (average age: 66 years) from 2011 to 2020 and found that after CABG, approximately 20% of men experienced stroke, kidney failure, reoperation, or sternum infection. It was also revealed that he had complications such as having to be on a ventilator for a long time. Use and hospitalization. More than 28% of women did so.
The study “should be considered a skyrocket for all clinicians who care for women,” said an accompanying editorial. But to heart researchers, the results seemed familiar.
“We’ve known this since the 1980s,” says Dr. C. Noel Bailey Mertz, a cardiologist and researcher at Cedars-Sinai Medical Center. Heart disease remains the leading cause of death for American women, she noted.
For CABG, “there was a general belief that things were getting better because technology, knowledge, skills and training were all improving,” she said. It’s “very disappointing” to see the gender gap persist.
Several factors help explain these differences. Gaudino says women who undergo bypass surgery look 3 to 5 years older than men, in part because “coronary artery disease can be recognized more easily and earlier in men.” “For men, there’s the classic presentation you learn in medical school. Women have different symptoms.” These can include fatigue, shortness of breath, back and abdominal pain, and more.
Less than 20 percent of patients enrolled in clinical trials are women, he added, and “what we’ve been taught is essentially based on studies of men.”
Because women are older (approximately 40% are over 70), they are more likely than men to have health problems such as diabetes, high blood pressure, and vascular disease, “all of which put them at risk for heart surgery.” Dr. Gaudino said. . Surgery can also be more complicated because the blood vessels are smaller and more fragile.
This disparity also affects other cardiac treatments and surgeries. A 2020 review of randomized trials reported worse outcomes for women than men five years after stent insertion.
They are “less likely to be prescribed and take statins, and especially less likely to take the most lifesaving high-intensity statins,” Dr. Bailey Merz said. “The list goes on.”
When CABG works well, the results can feel like miracles. Rhonda Skaggs, 68, underwent quadruple bypass surgery in July 2022 and spent 12 days in intensive care before returning home to Brooksville, Florida. Six months passed before she returned to her job at a Home Shopping Network outlet store.
“Now, no one would know that I had open heart surgery,” she said. “I walk 10,000 steps every day. I teach line dancing classes twice a week. I have my life back.”
But Susan Leary, 71, a former New York City teacher who now lives in Fuquay-Varina, North Carolina, is facing a second surgery after undergoing bypass surgery at Duke University last month.
“Women are less likely to have all vessels that need bypass bypassed,” said cardiothoracic surgeon Dr. Brittany Zwischenberger, co-author of the editorial in JAMA Surgery.
A few years ago, Leary was looking for surgery to shrink the “ugly-looking” varicose veins on her legs. Currently, she lacked blood vessels available for her transplant. “How did you know you needed that blood vessel in your heart?” she said.
She had a double bypass instead of the required triple bypass, meaning “incomplete revascularization.”
“That may contribute to worse outcomes and future interventions,” Dr. Zwischenberger said. “Fortunately, she is a candidate for a stent for the third blocked artery. This involves inserting a mesh tube into her blood vessel to open it up.” The procedure is scheduled for next month.
Advocates for improved care for women argue that the risks of surgery for women can be reduced.
Dr. Lamia Harik, a cardiothoracic surgery researcher at Weill Cornell Medicine, and her colleagues found that nearly 40% of deaths in women during CABG are attributable to intraoperative anemia. (Their study is in print.)
This is a large cardiopulmonary bypass machine (“pump”) in which the surgical team administers fluids to dilute the patient’s blood during surgery, and which oxygenates the blood and keeps it flowing while the surgeon performs the transplant. ) occurs when making it available.
“This is something that can be fixed,” Dr. Harrick says. For women, the surgeon may use a smaller pump, add less fluid, or both.
To learn more, Dr. Gaudino and other researchers began enrolling only women in two new clinical trials. The international ROMA study is the first all-female surgical trial and will investigate two CABG techniques to see which one provides better results.Federally funded Recharge trial compares stenting to CABG
Ms Mosson was briefly readmitted to the hospital because of fluid in her lungs, but surgeons said they were satisfied with the results of her quadruple bypass surgery. She began a three-times-a-week cardiac rehabilitation program recommended for patients who have had bypass surgery, and noticed that her strength was improving.
Like Skaggs and Leary, she is still dealing with the emotional aftermath of the heart attack and surgery. They described a state of shock and none had a history of heart disease. Depression and anxiety. “I’m still battling the fear that this will happen again,” Mosson said.
One of the antidotes for Leary was being recruited by ROMA. Duke is one of the clinical trial sites. She jumped at the chance to enroll her.
“Let me be a part of it,” she said. “Maybe her daughter will need this information someday too.”
