Late clinical results of coronary artery surgery
Eleven years of coronary artery surgery were surveyed through a computerized cardiovascular information registry. Longevity information from our first experience (1967 to 1970) was compared with a later series (1971 to 1973). These comparative series constitute our early and long-term results in elective isolated bypass graft operations. Patients with histories of heart failure, recent unstable angina or infarction, and those who had left main coronary obstruction were included. However, emergency operations, reoperations, and combined procedures were excluded.
A review of preoperative clinical characteristics indicates a rising median age: 1967 to 1970, 50; 1973, 53; 1976, 55; 1978, 56. Other preoperative clinical variables did not change appreciably from year to year. The extent of coronary atherosclerosis, documented by angiography, changed markedly after the first experience. From 1967 to 1970, 56% of patients h ad single-vessel disease; thereafter the prevalence of multiple-vessel disease rose consistently to 89% in 1978. The prevalence of critical left main coronary artery lesions ranged from 8% to 12%. Left ventricular asynergy occurred in 41% in the first series and increased to 54% in 1978. Angina is the prime indication for revascularization. Congestive heart failure alone is a relative contraindication.
The operative mortality was highest from 1967 to 1970 (3%). In the first 11.5 years the operative death rate was 1.1% and from 1971 through 1978 was 0.9%. The number of grafts per patient steadily increased from 1.5 in the first series to 2.5 in 1978. In the face of a higher risk population, morbidity has diminished.
Major . . .