An 11 year evolution of coronary arterial surgery (1968-1978)

• Published in: Annals of surgery Vol. 190; no. 4; pp. 444 - 455
• Main Authors: Loop, F D, Cosgrove, D M, Lytle, B W, Thurer, R L, Simpfendorfer, C, Taylor, P C, Proudfit, W L
• Format: Journal Article
• Language: English
• Published: United States 01.10.1979
• Subjects: Aged; Blood Transfusion; Cerebrovascular Disorders - etiology; Coronary Disease - diagnosis; Coronary Disease - surgery; Female; Gastrointestinal Hemorrhage - etiology; Graft Survival; Hemorrhage - etiology; Humans; Intraoperative Complications; Male; Middle Aged; Mortality; Myocardial Infarction - etiology; Myocardial Revascularization - methods; Myocardial Revascularization - mortality; Postoperative Complications; Respiratory Insufficiency - etiology; Saphenous Vein - transplantation; Transplantation, Autologous
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-197910000-00004

All patients who underwent isolated myocardial revascularization procedures from 1967-70 (n = 741) were compared with the first 1,000 patients who received similar elective operations each year from 1971 through 1978. Data from these eight years were processed through a computerized cardiovascular information registry. Median age increased from 50 to 56 years, multiple-vessel disease increased from 44 to 89%, and left ventricular asynergy from 41 to 54%. The number of grafts per patient increased from 1.5 to 2.5 and yet morbidity declined in every category except neurologic deficit. Operative mortality was 1.1% from 1967 through 1978 and 0.9% from 1971 through 1978. Graft patency was determined for 475 patients from 1967-70, 553 patients from 1971, 519 from 1972, and 540 from 1973. Patency rates after a mean catheterization interval of 21 months were 77, 77, 84, and 87% respectively. Higher graft patency coincides with introduction of the internal mammary artery graft. Five year follow-up was completed for the 1967-1970 series and 1971, 1972, and 1973 cohorts. Actuarial five year survival was 89.6, 91.6, 93.2, and 91.7%. Five year survival comparisons between 1967-1970 patients and 1971-1973 patients in single-, double-, and triplevessel disease categories show significant extended longevity in the later experience. Abnormal ventricular function and incomplete revascularization adversely influenced longevity (p < 0.05) in all years surveyed. In those series the percentage of asymptomatic patients at five years was 66, 65, 69, and 67%. Lower risk and higher five year survival are attributed to greater technical experience, changing technology, and improved management rather than to selection of lower risk cases.