This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Duncan, A. Articles by Koch, C. Search for Related Content PubMed PubMed Citation Articles by Duncan, A. Articles by Koch, C.

---

LETTER TO THE EDITOR

There Are More Important Risk Factors That May Influence The Outcome in Female AVR Patients

Department of Cardiothoracic Anesthesia; Cleveland Clinic; Cleveland, Ohio; duncana{at}ccf.org

In Response:

Our investigation (1) accounted for 38 variables, representing important baseline characteristics and perioperative factors. Yet, similar to any retrospective, observational investigation, there may be determinants of outcome that may not have been captured. Although a properly designed, randomized, controlled investigation is the gold standard for studying the impact of variables on outcomes, one cannot randomize gender.

Contrary to Dr. Ishikawa’s comment (2), our analysis included multiple descriptive variables reflective of the severity of aortic valve disease, including aortic valve pathology, preoperative heart failure, atrial fibrillation, cardiogenic shock, New York Heart Association classification, left ventricular function, and others. Our manuscript suggested that left ventricular wall thickness may impact outcomes after aortic valve replacement, and this intriguing possibility deserves further study. Similarly, we discussed that technical difficulty with valve replacement may be influenced by gender. However, we doubt that quantitative scoring of technical difficulty by surgeons would be helpful. It is likely to be subjective and highly variable, and, subsequently, of little benefit. Duration of aortic cross clamp time was included as a surrogate for this variable. Regarding the additional variables that Dr. Ishikawa suggested, we agree that other factors including race and perioperative medications may influence outcomes. Importantly, in order to rule out a smaller difference in gender-related risk, a larger patient population is needed.

REFERENCES

1. Duncan AI, Lin J, Koch CG, Gillinov AM, Xu M, Starr NJ. The impact of gender on in-hospital mortality and morbidity after isolated aortic valve replacement. Anesth Analg 2006;103:800–8[Abstract/Free Full Text]
2. Ishikawa S. There are more important risk factors that may influence the outcome in female AVR patients. Anesth Analg 2007;105:541–2[Free Full Text]

This article has been cited by other articles:

				K. W. Hatton and R. M. Schell Cardioversion During Closed Chest Robotic Surgery: Relevance of Pad Position Anesth. Analg., August 1, 2007; 105(2): 542 - 543. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Duncan, A. Articles by Koch, C. Search for Related Content PubMed PubMed Citation Articles by Duncan, A. Articles by Koch, C.