Limits of coronary artery surgery. Clinical and postmortem findings

In the first series of 90 continuous patients with coronary artery disease 9 patients died after aorto-coronary bypass procedures (10%). There were 7 operative deaths, and 2 postoperative deaths (respiratory failure after bronchopneumonia and bleeding duodenal ulcer; acute necrosis of the liver following hepatitis). The study of the deceased patients made evident that postoperative impairment of left ventricular function is caused by ventricular aneurysms. This fact can be shown by the poor ventricular function with an elevated left ventricular enddiastolic pressure (LVEDP) of more than 18 mm Hg. The results in patients with congestive heart failure could not be improved by multiple bypass-grafts. Probably the prolonged surgical intervention may cause additional stress to the predamaged myocardium. So, in our group the indication for using multiple grafts in cases with ventricular aneurysm is confirmed with great caution.