An Appraisal of Coronary Bypass Grafting

Coronary artery surgery: indications and recent experience

“…These trends are described in some previous reports; no mortality for single vessel disease and 26 10% mortality for triple vessel disease (Reul et al, 1972); 2 5% mortality for single vessel disease and 14-1 00 mortality for quadruple vessel disease (Najmi et al, 1974). However, this trend is not demonstrated in other reports Kouchoukos et al, 1974). Mortality for surgery in the presence of left main coronary artery disease is consistently high in reported series 8.2%/ (Pichard et al, 1973), 10-7%o (Zeft et al, 1974), 140/s (Takaro et al, 1976), 28 4°/ (Sharma et al, 1973), and 39°/ (Kisslo et al, 1973).…”

“…In reported series with mean length of follow-up between 6 months and 5 years after surgery those symptom-free ranged from 33 to 79%/ and improved from 60 to 96% with a tendency to deterioration of results with length of follow-up (Manley and Johnson, 1972;Reul et al, 1972;Collins et al, 1973;Hall et al, 1973;Sheldon et al, 1973;Cannom et al, 1974;Anderson et al, 1974;Kouchoukos et al, 1974;Najmi et al, 1974;Balcon et al, 1974;Bennett et al, 1974). Reported graft patency at 6-12 months after surgery is in the range 73-87°/ (Favaloro, 1972;Manley and Johnson, 1972;Reul et al, 1972;Kaiser et al, 1972;Hall et al, 1973;Sheldon et al, 1973;Anderson et al, 1974;Kouchoukos et al, 1974), and symptomatic results generally correlate well with this. In the present study, reinvestigation was not undertaken routinely but the excellent symptomatic results suggest adequate graft patency rates.…”

“…Previous reports state hospital mortality for uncomplicated bypass grafting in the range 1-3-12% (Favaloro, 1972;Manley and Johnson, 1972;Reul et al, 1972;Collins et al, 1973;Hall et al, 1973;Sheldon et al, 1973;Cooley et al, 1973;Forker et al, 1974;Cannom et al, 1974;Anderson et al, 1974;Najmi et al, 1974;Balcon et al, 1974;Bennett et al, 1974;Kouchoukos, Kirklin and Oberman, 1974). In the larger series comprising more than 500 cases (Favaloro, 1972;Manley and Johnson, 1972;Reul et al, 1972;Hall et al, 1973;Sheldon et al, 1973;Cooley et al, 1973;Cannom et al, 1974;Bennett et al, 1974;Kouchoukos et al, 1974) hospital mortality ranges from 1-3 to 7-1°0 with the Cleveland Clinic experience of 4935 bypass graft operations from 1967 to 1973 demonstrating an overall hospital mortality of 1-3°/ and a progressive decline in hospital mortality over the years with increasing experience and more exacting selection of patients for surgery, particularly the exclusion of those with severely impaired left ventricular function (Bennett et al, 1974).…”

“…In the larger series comprising more than 500 cases (Favaloro, 1972;Manley and Johnson, 1972;Reul et al, 1972;Hall et al, 1973;Sheldon et al, 1973;Cooley et al, 1973;Cannom et al, 1974;Bennett et al, 1974;Kouchoukos et al, 1974) hospital mortality ranges from 1-3 to 7-1°0 with the Cleveland Clinic experience of 4935 bypass graft operations from 1967 to 1973 demonstrating an overall hospital mortality of 1-3°/ and a progressive decline in hospital mortality over the years with increasing experience and more exacting selection of patients for surgery, particularly the exclusion of those with severely impaired left ventricular function (Bennett et al, 1974). Two other factors are perhaps of importance.…”

“…compared to 4%o for those with normal left ventricular end-diastolic pressure. In reported series, evidence of congestive cardiac failure resulted in increased hospital mortality from 1-9°/ to 29°/ (Kouchoukos et al, 1974) and from 3 9 to 19% (Kaiser et al, 1972) and elevation of left ventricular end-diastolic pressure (> 18 mmHg at rest) from 9 to 30%o (Kay et al, 1972).…”