Coronary artery bypass grafting shows impaired outcomes in women compared to men. Investigation of sex-related outcome differences mostly comprises different operative strategies, potentially hampering interpretation of data. We herein aimed to investigate sex-related outcome differences in on-pump procedures only.

All consecutive patients undergoing isolated on-pump bypass grafting between 2012 and 2021 at our centre were included in this study. Propensity score-matching was applied to compare outcomes of men and women. Kaplan-Meier analysis was used for investigating differences in survival probabilities. Identification of risk factors for long-term mortality was conducted by multivariable Cox regression.

In the matched cohort (326 pairs), women presented with a higher EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) and less prior surgery. Distribution of arterial, venous, and radial bypass grafts was similar between sexes. Women presented more often with superficial wound healing disorders (P = .004), a higher amount of red blood cell transfusions (P < .001), and a longer hospital stay. Mortality at 30 days, 1 year, and 10 years revealed no difference between sexes (10-year mortality: men 27.7% vs women 22.6%; P = .228). Female sex was not significantly associated with long-term mortality.

On-pump CABG in women is not associated with a higher prevalence of early or long-term all-cause mortality. Female sex is not a risk factor for long-term mortality. Women need more red blood cell transfusions, present with more superficial wound-healing disorders, and have a longer hospital stay. These findings underscore the overall safety of on-pump CABG in women.