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Aortocoronary vein bypass in patients with angina pectoris
Insights
Aortocoronary bypass surgery for angina pectoris showed a 1.1% operative mortality and 93% clinical improvement. The study recommends bypass for most patients, except those with isolated right coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Angina pectoris management often involves surgical intervention.
- Aortocoronary bypass grafting (CABG) is a common treatment for severe coronary artery disease.
Purpose of the Study:
- To evaluate the efficacy and safety of aortocoronary bypass for angina pectoris.
- To identify patient subgroups that may not benefit from CABG.
Main Methods:
- Retrospective analysis of 90 patients undergoing CABG between May 1971 and April 1974.
- Assessment of operative mortality, clinical improvement, shunt patency, and graft occlusion.
Main Results:
- Operative mortality was 1.1% with no late deaths.
- 93% of patients experienced clinical improvement, and 92% had early shunt patency.
- Patients with isolated right coronary artery disease showed less benefit.
Conclusions:
- CABG is a low-risk, high-yield procedure for refractory angina pectoris.
- Consideration should be given to excluding patients with isolated right coronary artery disease.
- Multiple shunts and even occluded shunts (with at least one patent) can yield good results.
Abstract:
In the 3-year period from May 1971 to April 1974, 90 patients had aortocoronary bypass for angina pectoris at Ulleval Hospital. One patient died shortly after the operation (operative mortality 1.1%). There were no further deaths in the observation period. Clinical improvement was seen in 93% of the patients, early shunt patency in 92%. The study suggests that patients with isolated affection of the right coronary artery should not have bypass, because these patients 1) had less severe symptoms, 2) had better preserved left ventricular function, and 3) seemed to have a smaller chance of benefiting from the operation than the other patients. Multiple shunts gave good clinical results and carried no higher surgical risk than did single shunts. Good clinical results were seen also in patients with occluded shunts provided they had at least one patent shunt too. Graft occlusion occurred early and was associated with low graft flow as measured intraoperatively. Graft occlusion was not usually followed by demonstrable myocardial necrosis. In view of the small operative risk and the high score of symptom relief it is concluded that all patients with angina pectoris that does not readily respond to medical treatment, should be considered for aortocoronary bypass.