Survival following bypass graft surgery
Edwin L. Alderman, M.D.
Christopher R. Brown, M.D.
Gary R. Sanders, M.D.
Edward B. Stinson, M.D.
The initial 400 patients having coronary bypass graft surgery at Stanford University Medical Center have been followed at annual intervals since the time of their surgery between 1969 and 1971. After excluding those with concomitant aneurysmectomy or valve replacement, 341 consecutive patients have had sequential follow-up, 86% of whom are men and 63% of whom had prior myocardial infarction. Operative mortality in these 341 patients was 4.9%. A more recent series of 533 patients operated on between 1972 and 1973 yielded an overall operative mortality rate of 2.1%. Operative mortality was higher in women (4.3% versus 1.7%), higher in patients over age 65 (10.4% versus 2.3%), and higher in patients with left ventriculographic abnormality (3.1% versus 1.6%).
Left ventricular dysfunction not only increased operative risk but had a marked effect on long-term survival. Patients with moderate to severe left ventricular dysfunction had a 60% 5-year survival versus a 92% survival in patients with normal or mild left ventricular dysfunction. In sequential annual follow-up, the percentage of patients with congestive heart failure symptoms of Class III or IV severity remained between 8% and 12%/yr reflecting the fact that the major attrition of patients occurred from the subgroup with moderate to severe heart failure.
The date when surgery was performed affected not only operative mortality but also influenced long-term survival, as suggested by the data shown in Figure 1. These actuarial plots show a trend toward improved survival for those patients operated on in more recent years. The data are based on . . .