Myocardial revascularization in The Cleveland Clinic Foundation—1979

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Coronary artery surgery has entered the second decade of active clinical practice. Quantitative advances have occurred principally in anesthesia management, myocardial protection, blood conservation, pharmacologic and mechanical support of the circulation, postoperative monitoring, and operative experience. The consequence of this evolution is that myocardial revascularization is performed in both large referral centers and smaller community hospitals with potential for low morbidity and mortality and clear evidence of effective relief of symptoms and extended longevity.

Acceptance of the salutory effects on long-term survival by multiple bypass graft procedures1 has gained precedence so that debates about effectiveness have given way to careful analysis of late results. The question is not whether the operation is sound; the question is how long will the palliation last? There is good evidence that patients for whom the operation has been successful are well protected for at least the first 5 postoperative years.

Our initial experience in direct myocardial revascularization has been reported2 and compared with isolated myocardial revascularization procedures divided into 1000 patient cohorts from 1971 through 1978.3 In contrast to an operative mortality of 3% from 1967 to 1970, hospital mortality declined to 1% in the later experience, and virtually every form of morbidity with the exception of neurologic deficit decreased significantly. Whereas the 5-year survival for the early experience was 89.8% for a group in which 44% had multivessel coronary atherosclerosis, 5-year survival for 1971–1973 cohorts increased to 92.4%, despite the increase in prevalence of multivessel disease to 83%.

A periodic review of each . . .



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