An Appraisal of Coronary Bypass Grafting

Kouchoukos, N. T.; Kirklin, John W.; Oberman, Albert

doi:10.1097/00132586-197506000-00062

Cited by 5 publications

(13 citation statements)

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“…But the thoughtful observer must realize that there is still much that is not known about the effectiveness of ACBG when compared to the currently available nonoperative management of coronary artery disease (CAD) in the individual patient. [10][11][12][13][14][15][16][17] This concern was succinctly articulated by Kirklin'5 in the George C. Griffith Lecture in 1974: "Clearly we all have much to do to clarify the effectiveness of medical and surgical therapy in this disease. Therein lies our dilemma but also our challenge and our opportunity."…”

mentioning

confidence: 99%

The first decade of aortocoronary bypass grafting, 1967-1977. A review.

McIntosh¹,

Garcia²

1978

Circulation

194

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SUMMARY Despite a decade of experience with aortocoronary bypass grafting embracing 300,000 or more operations, indications for its use remain controversial. The controversy persists because of a lack of adequate controls with which to compare the clinical course of operated patients; only 1248 have been reported who have been studied in a carefully controlled and random manner.Benefit has been claimed frequently by comparing the course of patients treated surgically with medically treated patients followed the decade before. Such comparisons are not valid in view of the well documented changes in the natural history of coronary artery disease that have been occurring during the last decade.Despite a low operative mortality and rate of graft closure, available data in the literature do not indicate that initial symptomatic improvement necessarily persists, or that myocardial infarctions, arrhythmias, or congestive heart failure will be prevented, or that life will be prolonged in the vast majority of operated patients."It is much easier to write upon a disease than upon a remedy. The former is in the hands of nature and a faithful observer with an eye to tolerable judgment can not fail to delineate a likeness; the latter will ever be subject to the whim, the inaccuracy and the blunder of man."William Withering"

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mentioning

confidence: 99%

The first decade of aortocoronary bypass grafting, 1967-1977. A review.

McIntosh¹,

Garcia²

1978

Circulation

194

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“…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).…”

Section: Anatomicalmentioning

confidence: 84%

“…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;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;Sheldon et al, 1973;Cooley et al, 1973;Cannom et al, 1974;Bennett et al, 1974;Kouchoukos et al, 1974) (Forker et al, 1974), 6-4% (Balcon et al, 1974) and 12% (Najmi et al, 1974).…”

Section: Anatomicalmentioning

confidence: 99%

“…In the larger series comprising more than 500 cases (Favaloro, 1972;Manley and Johnson, 1972;Reul et al, 1972;Sheldon et al, 1973;Cooley et al, 1973;Cannom et al, 1974;Bennett et al, 1974;Kouchoukos et al, 1974) (Forker et al, 1974), 6-4% (Balcon et al, 1974) and 12% (Najmi et al, 1974). The possible influences on hospital mortality in uncomplicated bypass grafting are considered separately to demonstrate trends although clearly in many instances these risk factors are not independent and act either through increasing extent and severity of coronary artery disease or through deterioration of pre-operative left ventricular function.…”

Section: Anatomicalmentioning

confidence: 99%

“…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). …”

Section: Anatomicalmentioning

confidence: 99%

See 2 more Smart Citations

Coronary artery surgery: indications and recent experience

Robinson

Coltart

Jenkins

et al. 1978

Postgraduate Medical Journal

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Untitled

1979

Clinical Cardiology

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Summary:Exercise tolerance was repeatedly determined over a 2-year period in a series of 100 patients with coronary heart disease randomly allocated for medical therapy and coronary bypass surgery. The surgical group had a consistently better exercise tolerance than the medical group during the whole follow-up. Completeness of the revascularization, assessed by repeated graft and native vessel angiography, resulted in a marked improvement whereas incompletely revascularized patients exhibited only a marginal improvement which, nevertheless, to some degree exceeded the result of medical management alone.It is concluded that coronary bypass surgery and medical therapy, when indicated, result in markedly better exercise tolerance than medical management alone. This improvement persists up two years after the operation and is largely dependent on the completeness of the revascularization.

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An Appraisal of Coronary Bypass Grafting

Cited by 5 publications

References 0 publications

The first decade of aortocoronary bypass grafting, 1967-1977. A review.

The first decade of aortocoronary bypass grafting, 1967-1977. A review.

Coronary artery surgery: indications and recent experience

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