Coronary arterial surgery

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Myocardial revascularization for arteriosclerotic disease with the bypass technique has been used at the Texas Heart Institute for a decade. Before that we had used the technique to correct certain anomalies of the coronary anatomy in instances of anomalous origin of the left and right coronary artery to restore a two-vessel coronary system.

Prior to December 31, 1978, a total of 15,487 patients had undergone operation with fresh saphenous vein autografts (Table 1). Of these, 13,049 patients had the bypass procedure as the only cardiac procedure; and in the majority the indication included angina pectoris, which was inadequately controlled by medical therapy. In those patients for whom follow-up was possible 90% were improved and more than 60% were symptom free. In early experience single and double bypass were frequently done, but more recently the trend has been toward triple, quadruple, and quintuple bypass with asequential grafts with side-to-side anastomoses. Results in the more extensive or complete revascularizations revealed no increase in early mortality even though the patients were presumably at higher risk. Moreover, most of the patients who had to undergo a second procedure later were discovered to have unbypassed stenoses demonstrable on the initial arteriograms. During the 10-year period surgical mortality has steadily decreased, and during the past 2 years the rate has been less than 2%.

Other lesions operated upon at the time of saphenous vein bypass included postinfarction aneurysm, aortic valve, mitral valve and other lesions of the lung, ascending or abdominal aorta, or gastrointestinal organs (Table . . .



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