• Christine Friedrich, Rouven Berndt, Assad Haneya, René Rusch, Rainer Petzina, Sandra Freitag-Wolf, Joachim Cremer, and Grischa Hoffmann.
• Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
• Interact Cardiovasc Thorac Surg. 2020 Mar 1; 30 (3): 380-387.

ObjectivesFemale gender is reported as an independent risk factor for a poor outcome after coronary artery bypass grafting. We analysed the influence of gender on surgical outcome in patients with single-vessel disease undergoing minimally invasive direct coronary artery bypass (MIDCAB).MethodsFrom January 1998 to December 2016, a total of 607 consecutive patients with single-vessel disease (31.9% women) underwent MIDCAB at our institution. Major adverse cardiac and cerebrovascular events (MACCE) were recorded during a median follow-up period of 8.0 years. Survival time was estimated for all patients and after applying propensity score matching (138 women vs 138 men). Multivariable Cox regression analysis identified risk factors predicting a long-term mortality rate.ResultsIn women, a longer surgical time (125 vs 113 min; P < 0.001) and a higher transfusion rate were recorded (13.0% vs 5.1%; P = 0.001) with similar rates of in-hospital deaths (1.0% vs 0.5%; P = 0.60) and MACCE (1.5% vs 0.7%; P = 0.39). Survival and MACCE-free survival during the follow-up period did not differ significantly between genders (P = 1.0, P = 0.36). Survival and MACCE-free survival rates after 5 years were 94% and 90% in women compared to 91% and 86% in men. Propensity score matching demonstrated improved long-term survival rates in women (P = 0.029). Insulin-dependent diabetes mellitus, postoperative atrial fibrillation and prolonged intensive care unit stay were associated with long-term deaths for both genders, whereas obesity, former myocardial infarction and preoperative atrial fibrillation were significant risk factors in men.ConclusionsFemale patients showed no adverse outcomes after MIDCAB, although risk factors were gender-specific. Overall, MIDCAB demonstrated excellent short- and long-term results as a treatment for single-vessel disease in both genders.© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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