Direct myocardial revascularization — 1976

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Nearly a decade of experience with graft techniques for coronary artery disease has accumulated since our initial clinical application in May 1967.1 Since previous attempts at myocardial revascularization were associated with clinical results that were unpredictable and frequently less than completely satisfactory, the early results of bypass graft surgery were also viewed with skepticism. In the past several years, however, there has been increasing agreement that direct myocardial revascularization with bypass graft techniques can result in improvement in symptoms, and improved effort tolerance and myocardial performance under stress. Long-term follow-up studies suggest that bypass graft surgery may improve long-term prognosis,2,3 inferring that the myocardium is protected against infarction and fatal arrhythmia. Although studies are still in progress, it has been suggested that bypass graft surgery may be of benefit in the more acute ischemic syndromes of unstable angina pectoris and acute myocardial infarction.4 This report is an update of the Cleveland Clinic Experience.

From May 9, 1967, through December 31, 1975, 10,744 patients underwent various types of graft procedures for coronary artery disease, with or without associated procedures, at the Cleveland Clinic (Table 1). The interposed graft for the right coronary artery was used in fewer than 100 patients, and was rapidly replaced by the bypass technique because of its greater versatility. Although the autologous saphenous vein had been used for grafting purposes in most patients, internal mammary artery (IMA) grafts have been employed with increasing frequency since 1971.5 Grafts using segments of autologous radial artery, cephalic veins, or prosthetic. . .



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