Treatment of Severe Coronary Artery Disease with 5, 6, and 7 Saphenous Vein Bypasses: Review of 131 Consecutive Patients

Geisler, Gerald F.; Adam, Maurice; Mitchel, Ben F.; Lambert, Cary J.; Thiele, Jörn

doi:10.1016/s0003-4975(10)63751-4

Cited by 12 publications

(5 citation statements)

References 14 publications

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“…An increase in the mean number of vessels bypassed per patient has been reported in recent years, indicating more persistent attempts to obtain "complete" revascularization than were made 2-4 years ago [42]. This may not necessarily improve long-term survival, however, judging from a report by McNeer et al [43].…”

Section: Preliminary Findingsmentioning

confidence: 98%

Results of a randomized study of medical and surgical management of angina pectoris

Takaro

1978

World j. surg.

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Of 686 male adults randomly allocated to 2 treatment groups in the 3 years 1972, 1973, arid 1974, there were 354 assigned to the medical (control) group and 332 assigned to medical plus surgical treatment (in 95% of cases, to saphenous vein aortocoronary bypass procedure alone). There were no statistically significant differences between the 2 groups in any of 35 different clinical, electrocardiographic and arteriographic characteristics at baseline, except for serum cholesterol, so the 2 groups were judged to be comparable. Twelve percent of patients were found to have significant disease of the left main coronary artery, in almost all instances in addition to disease of other vessels. For this subgroup, surgery was associated with increased survival (at 4 years, p < 0.001). For the remaining 88% of patients, and for the 6 subgroups into which they could be categorized on the basis of extent of disease and status of left ventricular function, no significant differences in survival could as yet be identified in these preliminary analyses. Another important finding was that inclusion of patients with left main coronary artery disease in the analyses of subgroups with 3-vessel disease gave results for survival favoring surgically randomized patients, to a statistically significant degree. If patients with left main coronary artery disease were excluded, the difference in survival between medically and surgically treated patients was no longer statistically significant. Medically treated patients had better survival rates than earlier reports in the literature had indicated.

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Section: Preliminary Findingsmentioning

confidence: 98%

Results of a randomized study of medical and surgical management of angina pectoris

Takaro

1978

World j. surg.

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“…In numerous studies, outcome analysis following coronary artery bypass graft (CABG) focuses on variables (age, gender, comorbidities, surgical technique, treatment modality, time intervals, and risk factors) rather than the particulars of the revascularization itself 39‐41 , 44‐45 , 47 , 53 , 69‐72 . Insufficient large patient population, and even a lesser patient cohort in subsets, makes statistical analysis and the drawing of significant conclusions an impossibility 45 , 47 , 51 , 66 , 73‐77 . Therefore the impact of the extent and distribution of coronary revascularization upon long‐term outcomes cannot be ascertained from these studies.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Some of these patients were under‐revascularized, however, with only two grafts constructed per patient so that useful information regarding the benefits of complete revascularization is lost. In his report on a limited series of 131 patients with five to six bypasses, Geisler documents the number of bypasses to each vessel; however, no comparison is made to less revascularized patients and the followup is short and incomplete 74 …”

Section: Review Of the Literaturementioning

confidence: 99%

“…[39][40][41][44][45]47,53,[69][70][71][72] Insufficient large patient population, and even a lesser patient cohort in subsets, makes statistical analysis and the drawing of significant conclusions an impossibility. 45,47,51,66,[73][74][75][76][77] Therefore the impact of the extent and distribution of coronary revascularization upon long-term outcomes cannot be ascertained from these studies.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…In his report on a limited series of 131 patients with five to six bypasses, Geisler documents the number of bypasses to each vessel; however, no comparison is made to less revascularized patients and the followup is short and incomplete. 74 The definitions of "completeness" of revascularization vary greatly among the studies under review or are absent altogether. 41,43,46,51,53,65,68,73,79,[89][90][91][92][93][94] Some consider revascularization "complete" only if all vessels, measuring at least 1 mm in diameter with >50% luminal reduction, are bypassed.…”

Section: Review Of the Literaturementioning

confidence: 99%

See 2 more Smart Citations

Beyond Complete Myocardial Revascularization: Is It Important and Does It Matter?

Nathanson

Ihnken

2003

Journal of Cardiac Surgery

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Constructing more than one graft per coronary system (left anterior descending, circumflex, right) has been widely and enthusiastically practiced for many years because it was thought to confer long-term freedom from major adverse coronary events. In reality the medical and surgical literature do not document the importance of maximizing the number of coronary vessels bypassed beyond one per system. Published series exhibit great variation in patient cohort, length of follow-up and lack the whole gamut of clinical endpoints. None of the published series provide an analysis based on subset stratification according to detailed coronary vessel anatomopathologic inventory in relation to revascularization strategy.

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Coronary Artery Surgery

Harlan

Starr

Harwin³

1980

Comprehensive Manuals of Surgical Specialties

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Treatment of Severe Coronary Artery Disease with 5, 6, and 7 Saphenous Vein Bypasses: Review of 131 Consecutive Patients

Cited by 12 publications

References 14 publications

Results of a randomized study of medical and surgical management of angina pectoris

Results of a randomized study of medical and surgical management of angina pectoris

Beyond Complete Myocardial Revascularization: Is It Important and Does It Matter?

Coronary Artery Surgery

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