Coronary Artery Bypass

Rj, Hall; Jt, Dawson; Da, Cooley; Gl, Hallman; Fm, Sandiford; Dc, Wukasch; Garcia, Efrain

doi:10.1007/978-1-4615-9020-0_18

Cited by 5 publications

(1 citation statement)

References 4 publications

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“…Similar 5-year survival data from a series of nearly 1,000 patients were recently reported by Mills and Ochsner [18]. A 4-year survival rate of 83% has been reported in 1,100 patients from the Texas Heart Institute [19], and a survival rate of about 83% in more than 1,000 patients has been reported from the Cleveland Clinic [12].…”

Section: Longevity Considerationssupporting

confidence: 81%

The influence of coronary bypass grafting on longevity

Spencer

Isom

1978

World j. surg.

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Of 1,219 patients who underwent elective coronary bypass grafting for severe angina between 1968 and 1975 at New York University, the 5‐year survival rate calculated by the life table method was 88%, suggesting that longevity was greatly improved. These data are far better than those reported in most nonoperative series. The data can be criticized, of course, as not being obtained from a randomized trial, but the fact that such a high survival rate was obtained in patients with angina not responding to medical therapy seems highly significant. Randomization studies are currently being done in collaboration with other universities under the auspices of the National Institutes of Health in patients with mild, stable angina and in asymptomatic patients following myocardial infarction. For the future, several goals may be projected, considering both the prevalence and the wide range in clinical severity of the disease. Undoubtedly, certain patients do not need operation because the disease process is mild and collateral circulation is adequate. Equally obvious is the fact that certain patients with disabling angina urgently need operation to survive. A current, somewhat conservative, approach is to employ medical therapy for 6–12 months after onset of symptoms if possible, and then determine if significant ischemia remains. If collateral circulation does not become adequate within this time, operation should be seriously considered. The importance of starting medical therapy beforehand is important not only to determine the necessity for bypass grafting but also to maintain medical therapy in the postoperative years. Of course, operation does nothing for the fundamental atherosclerotic process, so long‐term control of the disease depends on nonoperative methods of control of the atherosclerotic process. A particularly troublesome question at present, about which there are sharp differences of opinion, is whether asymptomatic patients with triple vessel disease demonstrated on angiography should be operated upon regardless of symptoms. This is a particularly important group for randomization. At New York University, we have usually not recommended operation unless significant symptoms were present. A noninvasive method of determining the severity of coronary disease, perhaps a modification of exercise electrocardiography and echocardiography, would greatly simplify both the diagnosis of the disease and the effectiveness of different forms of therapy. It is to be hoped that this will emerge in the near future, perhaps in combination with certain types of radioisotope scanning.

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Section: Longevity Considerationssupporting

confidence: 81%