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Related Experiment Videos

Coronary bypass surgery: is the operation different today?

E L Jones1, W S Weintraub, J M Craver

  • 1Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.

The Journal of Thoracic and Cardiovascular Surgery
|January 1, 1991
PubMed
Summary

Coronary bypass grafting patients became older and sicker between 1981 and 1987, leading to increased morbidity and mortality. However, outcomes for younger, healthier patients remained stable.

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Area of Science:

  • Cardiovascular Surgery
  • Medical Outcomes Research

Background:

  • Coronary artery bypass grafting (CABG) procedures have evolved.
  • Patient demographics and disease complexity have changed over time.

Purpose of the Study:

  • To analyze changes in patient characteristics and outcomes for isolated coronary bypass grafting between 1981 and 1987.
  • To identify trends in morbidity and mortality associated with CABG over a six-year period.

Main Methods:

  • Comparative analysis of two patient cohorts from 1981 (n=1586) and 1987 (n=1513).
  • Evaluation of preoperative and postoperative variables, including patient age, comorbidities, disease severity, left ventricular function, and surgical techniques.
  • Subgroup analysis based on prior procedures, patient age, and left ventricular function.

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Main Results:

  • Patients undergoing CABG were older, more frequently diabetic, had more triple vessel disease, and poorer left ventricular function in 1987 compared to 1981.
  • Internal mammary artery grafting use increased significantly from 1981 to 1987.
  • Major postoperative morbidity (e.g., need for intraaortic balloon pumping, myocardial infarction, stroke, wound infection) and hospital mortality increased significantly in the total population.
  • Outcomes for the 'optimal' subgroup (younger patients with good ejection fraction and no prior procedure) showed no significant increase in morbidity or mortality.
  • The proportion of patients in the 'optimal' group decreased significantly over the study period.

Conclusions:

  • The trend in CABG surgery has shifted towards treating older, sicker patients with more complex coronary artery disease.
  • While overall morbidity and mortality have increased, outcomes for the best surgical candidates have remained stable.
  • The increased use of internal mammary artery grafting may reflect evolving surgical practices.