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[Indications for surgery of the coronaries and its results (author's transl)]
Insights
Coronary artery bypass surgery is recommended for chronic angina patients with severe blockages and good heart function. Immediate surgical intervention is advised for pre-infarct angina and certain post-infarct conditions, though long-term survival benefits require further study.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Medicine
Background:
- Chronic angina pectoris often necessitates surgical intervention for patients with specific coronary artery conditions.
- The decision for surgical revascularization is influenced by the extent of coronary artery disease and ventricular function.
Purpose of the Study:
- To outline the indications for surgical intervention in chronic angina pectoris.
- To discuss the timing and necessity of surgical treatment for pre-infarct and post-infarct syndromes.
- To evaluate the current understanding of surgical outcomes, including quality of life and survival rates.
Main Methods:
- Review of indications for coronary artery bypass grafting in chronic angina.
- Analysis of treatment strategies for unstable angina and post-infarct complications.
- Discussion of existing statistical data and prospective studies on surgical outcomes.
Main Results:
- Surgery is indicated for central stenoses if distal vessels are suitable and ventricular function is adequate.
- Revascularization is an absolute indication for main left coronary artery stenoses.
- Immediate surgery is recommended for pre-infarct angina in younger patients with severe coronary changes.
- Post-infarct ventricular aneurysms require surgery if left-sided insufficiency or arrhythmias worsen.
Conclusions:
- Careful patient selection allows for surgery with acceptable risk, potentially improving quality of life.
- Long-term survival prediction post-surgery remains uncertain due to a lack of definitive comparative studies.
- Existing data, including a 2-year follow-up study, shows no significant difference in survival between surgical and conservative treatment groups, but requires more extensive research.
Abstract:
In chronic angina pectoris surgery is indicated for all patients with bridgeable central stenoses, suitable distal vessels and patent peripheral coronary circulation, if function of the ventricle is not critically reduced. when more than one vessel is diseased and with isolated stenoses of the anterior interventricular branch of the left coronary a., it does hardly latter whether the angina pectoris can be treated conservatively or not. An absolute indication for revasculariation exists when stenoses of the main branches of the left coronary artery can be shown. Pre-infarct angina (unstable or crescendo-angina, threatened infarction) should, in younger patients, always lead to immediate diagnostic ascertainment. Where severe anatomic coronary changes are present, immediate surgery is indicated, although the real danger of infarction in such patients cannot be reliably predicated as yet. Post-infarct ventricular aneurysmus should be operated on when leftsided insufficiency increases or arrythmias cannot be controlled satisfactorily any more. Surgery can be undertaken with an acceptable risk, if patients are carefully selected. As far as we know from published statistics, the quality of life of such patients can be improved for some time. But their expectation of life after surgery cannot as yet be reliably predicted, because prospective observations of comparable groups of patients treated conservatively or surgically do not yet exist. From a prospective study of McNeer (22) it appears that in 2 randomized groups there was no significant difference in time of survival after 2 years. Neither the size of the material nor the period of follow-up are sufficient for definite evaluation.