A. Hamed

The Impact of On-pump Coronary Artery Bypass Surgery vs. Off-pump Coronary Artery Bypass Surgery on Sexual Function

INTRODUCTION Erectile dysfunction and ischemic heart disease are common health problems that affect elderly individuals. Despite advances in treatment strategies, cardiopulmonary bypass (CPB) has been used for coronary artery bypass grafting (CABG) for over three decades for surgical myocardial revascularization. AIM To discuss the difference between the on pump and the newer alternative-the off-pump CABG (OPCABG) surgery-on the sexual function. METHODS This prospective study included 100 patients who underwent CABG. MAIN OUTCOME MEASURES The patients were evaluated by an abridged form of International Index of Erectile Function questionnaire (IIEF-5), Pharmaco-Penile Duplex Ultrasound and finally by the European System for Cardiac Operative Risk Evaluation. The patients were underwent either on-pump CABG or OPCABG. Six months after surgery, the erectile function was revaluated according to the same preoperative measures. RESULTS Patients included in the study were classified into two matched groups: group I-patients who underwent on-pump CABG (N = 50); and group II-patients who underwent OPCABG (N = 50). The frequency of intercourse was significantly higher in OPCABG (P < 0.05) after surgery. The mean +/- standard deviation of the IIEF-5 scores of the on-pump group postoperatively became 12.48 +/- 7.19 whereas it became 15.88 +/- 6.67 in the off-pump group (P < 0.05). Moreover, the number of patients who reported postoperative improvement of their IIEF-5 score was significantly higher in OPCABG group (N = 23) compared with the conventional on-pump CABG group (N = 13) (P < 0.05). There was no significant change in the duplex ultrasound after surgery between both groups. CONCLUSIONS The OPCABG has a diminished impact on the sexual function of patients compared with the conventional on-pump CABG. Therefore, the type of operation can be considered a predictive factor of sexual function following CAB surgery.

Vascular Risk Factors as Predictors of Sexual Function Following Coronary Artery Bypass Graft

INTRODUCTION A strong association between cardiovascular risk factors and erectile dysfunction (ED) was suggested. Coronary artery bypass grafting (CABG) is the gold standard for surgical myocardial revascularization. AIM We herein evaluate the impact of vascular risk factors on postoperative sexual functions in patients undergo CABG. MAIN OUTCOME MEASURES ED severity by the International Index of Erectile Function (IIEF-5) and penile duplex study. METHODS The present study included 100 patients who underwent CABG. The patients were evaluated by an abridged form of the IIEF-5 questionnaire, followed by CABG. Six months after surgery the erectile function of all patients was re-evaluated utilizing the IIEF-5. RESULTS Number of risk factors was significantly associated with postoperative change in IIEF-5 score (P = 0.02). A post hoc analysis of the association revealed that patients with one risk factor were significantly more likely to have increased IIEF-5 scores (N = 18), whereas those with two or more risk factors were significantly more likely to have decreased IIEF-5 scores (N = 21, P < 0.05). Furthermore, those with no risk factors were significantly more likely to be stable (N = 8) compared with those with more than two risk factors, who were more likely to have decreased scores (P < 0.05). The hierarchical logistic regression results showed that when examining all risk factors simultaneously, because of multicollinearity, only hyperlipidemia was significantly associated with postoperative ED (odds ratio [OR] = 11.33, confidence interval [CI] = 1.25, 102.82). Frequency of intercourse was also significantly associated with postoperative ED after controlling for risk factors (OR = 0.71, CI = 0.52, 0.97). CONCLUSIONS This data clearly shows that the number of cardiovascular risk factors is an essential predictive factor for sexual function following surgery. Only hyperlipidemia may play a predictive role for the future sexual function of patients undergo CABG.

Correlation Between the European System for Cardiac Operative Risk Evaluation and Sexual Function After Coronary Artery Bypass Graft Surgery

INTRODUCTION The published studies discussing the prognostic factors for expected sexual function after coronary artery bypass graft (CABG) are still limited. AIM Examining the correlation between the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the abridged form of International Index of Erectile Function questionnaire (IIEF-5), as a quick and inexpensive tool for the cardiologist to predict the sexual function after CABG. MAIN OUTCOME MEASURES Validated standardized questionnaire commonly used by cardiologists in identifying appropriate weight to various risk factors related to adult cardiac operations. METHODS Preoperatively patients were evaluated as regards to the sexual function by (IIEF-5) and pharmaco-penile duplex ultrasound. Moreover all patients were evaluated bu EuroSCORE. Six months after surgery, the erectile function of all patients was revaluated according to the same preoperative procedures. The patients were categorized with EuroSCORE as follows: The low-risk group (EuroSCORE 0–2), the medium-risk group (EuroSCORE 3–5), and the high-risk group (EuroSCORE 6 plus). RESULTS The EuroSCORE was negatively correlated with the IIEF-5 score (r = -0.224, P = 0.025 or rs = -0.259, P = 0.009). Moreover, low-risk patients had significantly higher IIEF-5 scores compared with medium-risk patients (mean standard deviation = 15.27 6.03 vs. 12.18 6.07, P < 0.05). CONCLUSIONS There is an inverse correlation between the components of EuroSCORE and the IIEF-5 score. Patients with higher EuroSCORE had lower IIEF-5 scores and vice versa. The EuroSCORE is a useful, quick, and inexpensive tool that allows prediction of ED in those patients with coronary artery disease patients who are undergoing CABG.

T09-O-33 Vascular risk factors as predictors for the sexual function following coronary artery bypass surgery

Introduction and objective Massachusetts Male Aging Study’ and the ‘Cologne Male Survey’ revealed an association of cardiovascular risk factors and ED with a prevalence of 30–75%of ED in cardiovascular high-risk patients. Coronary artery bypass grafting (CABG) is the gold standard for surgical myocardial revascularization. The published studies discussing the predictor factors of the future sexual function following CABG is limited. We herein evaluate the impact of vascular risk factors on the future sexual functions after CABG. Methods The study included 100 patients who underwent CABG. The patients were evaluated by abridged form of International Index of Erectile Function questionnaire (IIEF-5), Pharmaco-Penile Duplex Ultrasound. The patients were underwent CABG, six months later the erectile function of all patients was revaluated according to the same preoperative procedures. Results Preoperatively there was a significant correlation between age, diabetes mellitus, hypertension, hyperlipidemia and IIEF-5 scores (p Diabetes mellitus showed a positive correlation with the change in IIEF-5 scores after surgery (p Conclusions Only DM may predict the future sexual function in patients undergo CABG.

T09-O-32 Does EuroSCORE predict sexual function after cardiac surgery?

Introduction and objective Erectile dysfunction (ED) shared risk factors with coronary artery diseases (CVD). Coronary artery bypass grafting (CABG) is the standard for surgical myocardial revascularization. Although there is an association between CAD and ED yet most cardiologists do not ask about ED. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) gives appropriate weight to various risk factors in adult cardiac operations. We herein evaluate using the EuroSCORE in predicting the sexual function in patients undergo CABG. Methods The study included 100 patients who underwent CABG. The patients were evaluated by abridged form of International Index of Erectile Function questionnaire (IIEF-5), Pharmaco-Penile Duplex Ultrasound and finally by the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Six months after surgery all patients were revaluated according to the same preoperative procedures. Results The EuroSCORE results showed that 56/ 100 patients were low risk patients while 44/ 100 were medium risk patients. Preoperatively the EuroSCORE showed significant negative correlation to the IIEF-5 score (r = -0.229, p Conclusion We can conclude that the EuroSCORE is a useful, quick and inexpensive tool for prediction of ED in patients who undergoing CABG.

T09-P-09 Artery size hypothesis, does it exist?

Introduction Erectile dysfunction (ED) is related to atherosclerosis risk factors. Of clinical importance is the potential link between ED and coronary artery disease (CAD). Montoresi and his collegues 2004 proposed a pathophysiological mechanism termed the ‘artery-size hypothesis’ to explain the link between ED and CAD. They also postulated that if this hypothesis holds true, the chance of a patient with proved CAD having concomitant erectile dysfunction should be high. Moreover symptoms of ED should come before CAD symptoms. We evaluated this theory by detecting the distribution of ED in CAD patients and the onset of ED in relation to the occurrence of the first cardiac attack. Methods The present study included 100 patients with established ischemic heart disease. The patients were evaluated by abridged form of International Index of Erectile Function questionnaire (IIEF-5), Pharmaco-Penile Duplex Ultrasound. Results The results of the IIEF-5 questionnaire demonstrated 20/100 patients showed normal results while 80/100 patients showed ED. Among patients with ED (57.5%) reported the onset of ED before the occurrence of the first cardiac attack by a period of time ranging from 3 months to 10 years while (42.5%) experienced ED after the first cardiac attack in a period of 15 days to one year. Penile duplex results showed significantly higher incidence of arteriogenic factor (57 patients) compared to either venocclusive dysfunction (17 patients) or normal duplex results ( 6 patients) (p Conclusion We conclude that “artery size hypothesis” could explain the relation between the ED and the CAD.

T09-O-34 The impact of the coronary artery bypass surgery on the sexual function

Introduction ED is related to atherosclerosis risk factors. Of great clinical importance is the potential link between ED and coronary artery disease. Cardiopulmonary bypass (CAB) has been used for coronary artery bypass grafting (CABG) for over 3 decades for surgical myocardial revascularization. The published articles discussing the effect of CABG on sexual function are few. Moreover these studies were based on questionnaires rather than Penile Duplex in the evaluation of sexual function. We herein evaluate the impact of CABG surgery on sexual function. Methods The present study included 100 patients who underwent CABG. The patients were evaluated by abridged form of International Index of Erectile Function questionnaire (IIEF-5), Pharmaco-Penile Duplex Ultrasound and finally by the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Six months after surgery the erectile function of all patients was revaluated with the same preoperative procedures. Results Postoperatively patients reported a significant increase in the frequency of intercourse per month (p Postoperative readings obtained by the penile duplex showed no significant change but it showed an association with the change in sexual function postoperatively (p The EuroSCORE of patients showed a significant relationship to the change in erectile function after surgery (p Conclusions Preoperative factors like IIEF-5 score, penile duplex and the EuroSCORE may predict the impact of CABG on sexual function.