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[How hazardous is elective coronary bypass surgery? Perioperative course in 1000 consecutive patients]
1Hjertesenteret i Oslo.
Insights
Elective coronary artery bypass surgery demonstrates low mortality and morbidity rates, even in high-risk patients. This procedure offers excellent outcomes compared to alternative revascularization methods.
Area of Science:
- Cardiovascular Surgery
- Cardiac Procedures
- Surgical Risk Factors
Context:
- 1,000 consecutive elective coronary artery bypass operations performed over 30 months.
- Majority of patients had no left ventricular impairment.
- Over 66% had significant operative high-risk factors (e.g., age, diabetes, unstable angina).
Purpose:
- To evaluate the safety and efficacy of elective coronary artery bypass surgery.
- To assess perioperative complications, myocardial necrosis, and mortality rates.
- To compare outcomes with alternative revascularization procedures.
Summary:
- Low incidence of perioperative complications (2.4%) including myocardial infarction, wound infection, and neurological disorders.
- Myocardial necrosis observed in 3.1% of patients, often asymptomatic.
- Successful blood conservation program avoided homologous blood products in 96.4% of cases.
- Achieved a remarkably low in-hospital mortality rate of 0.1%.
Impact:
- Elective coronary artery bypass surgery can be performed with very low mortality and morbidity.
- Outcomes are highly favorable when compared to percutaneous transluminal coronary angioplasty (PTCA) and other revascularization techniques.
- Highlights the effectiveness of a comprehensive blood conservation strategy in cardiac surgery.
Abstract:
During a 30 month period, 1,000 consecutive elective coronary artery bypass operations were performed in 863 men and 137 women. The majority of the patients had no impairment of the left ventricle; more than 66%, however, had one or more operative high risk factors (old age, female sex, low ejection fraction, diabetes, overweight, unstable angina). Perioperative complications, which included prolonged stay in hospital, were noted in 24 patients (2.4%), due to myocardial infarction, wound infection or neurological disorder. Myocardial necrosis, diagnosed by new Q-waves and elevated enzymes, was demonstrated in 31 patients (3.1%), most of whom were asymptomatic. A consistent blood conservation programme resulted in avoidance of any homologous blood products in 96.4% of the patients. The mortality among hospitalized patients was 1/1,000 (0.1%). Elective coronary artery bypass surgery may be performed with a very low rate of mortality and morbidity, which compares very well with the results achieved after alternative revascularization procedures such as percutaneous transluminal coronary angioplasty (PTCA), laser angioplasty and arterectomy.