Survival following aortocoronary bypass graft surgery

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Survival was studied in 807 of the 1000 patients who had pure saphenous vein graft surgery between October 1969 and June 1974. Survival curves up to 6 years were determined for the entire population and various subsets on the basis of preoperative findings and surgical techniques using the actuarial method of Cutler and Ederer.

The 6-year survival was 82% for patients who had pure saphenous vein grafts and 66% for the 126 patients who also had internal mammary artery implantation or left ventricular wall resection or both (Table). Survival was significantly greater when the following preoperative conditions were noted: absence of heart failure, absence of significant angina (prophylactic surgery), normal electrocardiogram at rest, one or two obstructed arteries, ejection fraction ⪖0.45. Survival did not appear to be influenced by the patient’s age, risk factors, duration of illness before surgery, or previous myocardial infarction; the 6-year survival was not different for stable as opposed to unstable angina. Patients with one, two, or more grafts had a similar life span, but patients with optimal correction had a significantly greater longevity (bypass of all major coronary arteries with a stenosis ⪖70%).

When early mortality (first month) is excluded, the only factors which appear to determine late survival are heart failure, electrocardiogram, and ejection fraction (Table). The 6-year survival was also significantly greater in patients whose grafts were patent 6 to 18 months after surgery as opposed to that of patients in whom all grafts were occluded. Also, patients who still had an optimal . . .