Coronary Artery Surgery in the Nineties by M. E. M. Macedo (auth.), Universitäts-Professor Dr. med.

By M. E. M. Macedo (auth.), Universitäts-Professor Dr. med. Felix Unger (eds.)

In this ebook, the most recent leads to coronary artery surgical procedure are mentioned and the criteria decisive for long term diagnosis are elucidated. the indicators for re-operation are thought of and redefined, and the surgical process in regards to a number of skip is defined. the purpose of the booklet is to depict in actual fact long term prognoses and to determinate the long run wishes of coronary artery surgical procedure within the subsequent decade. This far-sighted procedure additionally makes the booklet a useful reference for the making plans and extension of cardiology facilities in Europe. 1

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Survival in our early operation group is similar to that of the surgical Veterans Administration group, with a 7-year sur- Long-Term Survival After Coronary Bypass 27 Table 3. Survival at 2, 5, and 7 years postoperatively in the early, middle, and recent operation groups, divided into one-, two-, and three-vessel disease and left main stenosis (figures are percentages) Survival at 2 years 5 years 7 years E M R E M R 1 2 3 LM 94 92 83 80 95 96 92 88 95 98 93 95 89 87 75 78 91 96 87 88 89 85 69 71 Total 88 93 95 82 90 78 E M R vival rate for all patients of 77% in the Veterans Administration material and 77% in our early operation group.

One of the main determinants of prognosis on medical therapy is left ventricular function. As prognosis in patients with normal LV function is good also on medical treatment, and as the life-prolonging effect of surgery becomes smaller within a IO-year period, surgery should be only cautiously advocated in patients with good LV function. The primary treatment in this group may well tum out to be coronary dilatation. Surgical treatment therefore should be shifted more to patients with poor LV function, as the difference between medical and surgical treatment becomes large and important.

In 1961, Ake Senning [25], still in Stockholm, published his case of coronary endarterectomy with patch graft enlargement, under profound hypothermia. The most important aspect of this operation was that angiography located the disease and confirmed the reestablishment of the circulation in the two arteries subjected to this technique (left anterior descending and circumflex). Soon after Favaloro described his operation, a number of European surgeons followed his path. Charles Hahn, Switzerland, Ross, Yacoub, and many others in the United Kingdom, Germany, and France quickly acquired a very important experience.

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