Survival following aortocoronary bypass graft surgery
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 . . .