Association between early graft patency and late outcome for patients undergoing artery bypass graft surgery.

Abstract

For a group of 658 patients who received coronary artery bypass graft surgery, we investigated the correlation between the degree of early (6 months) graft patency and recurrence of anginal symptoms, late myocardial infarction, and postoperative coronary-related death. The patients were grouped according to the number of surgically placed grafts, and each group was further subgrouped on the basis of the number of grafts functioning at the early postsurgical follow-up examination. The patients were observed over a period as long as 13 years. The frequency with which angina returned correlated significantly with the degree of patency within each of the groups (one, two, three, or four grafts); patients with a higher percentage of patent grafts experienced longer periods of freedom from angina. On the average, patients with all of their multiple grafts patent experienced at least 7 more years of symptomatic relief than their counterparts with all grafts occluded. Most surprisingly, the rate of the return of angina for those patients who had all grafts patent and were completely revascularized was independent of the number of diseased vessels or the number of grafts placed. The findings for coronary death and postoperative infarction showed similar trends. Circulation 69, No. 3, 569-576, 1984. NUMEROUS investigations have been conducted to compare the efficacy of surgical as opposed to medical treatment for coronary artery disease.`A Surgery is often considered the treatment of choice even for patients in whom it cannot be shown that the procedure prolongs life because of the potential for improved quality of life. Because many decisions are based on an expected decrease in morbidity, we investigated the relationship between early surgical success measured by graft patency and long-term outcome: return of anginal symptoms and incidence of late postoperative myocardial infarction, as well as late postoperative coronaryrelated death. MethodsThe records of the 658 patients who underwent coronary bypass graft surgery were entered in a computerized data base and analyzed by the HELP system for medical decision-making. Subsequently, 32 (5%) of the 658 patients underwent a sec-

Intermittent on-pump beating-heart coronary artery bypass grafting—a safer option

“…Surgically, the ON-BH CABG technique proposes to offer a more stable field for quality anastomosis when compared to the OPCAB technique because cardiac perfusion is maintained while at the same time, over distension of the heart is prevented [11][12][13]. Due to theoretical uncertainties regarding the ON-BH CABG technique, interest in this has not been significant and hence studies are scarce when we compare the other two strategies.…”

On-pump beating heart versus conventional coronary artery bypass grafting: comparative study on early and long-term clinical outcomes

“…This may be particularly advantageous in acute myocardial infarction or poor left ventricular function with low cardiac reserve as these patients may be unable to tolerate the extreme myocardial manipulation of OPCAB or the controlled ischemia of C-CABG (9,10,21,22). Compared with OPCAB, CPB-assisted beating heart surgery may afford a stable surgical platform for ensuring optimal anastomosis quality that would otherwise not be possible with OPCAB as the heart is continuously perfused while being protected from distention injury and the anastomosis site is securely stabilized (23)(24)(25).…”

Effects of myocardial revascularisation in patients with effort angina and those with effort and nocturnal angina.

“…103 (19) 96 (10) Duration of exercise to 1 mm ST depression (min) (Daytime ST changes) (Daytime and nocturnal ST changes)…”