[Aortocoronary bypass. Development of technics and indications over a 10-year period]

During the 1973-1983 period considerable changes have taken place in the techniques and indications of coronary bypass. In a homogeneous series of 3095 patients operated upon by the same group, changes in techniques have been: the introduction in routine coronary bypass of the membrane oxygenator which provides optimal biological conditions and the prolonged circulatory assistance so necessary to high risk patients, and the application to coronary bypass of microsurgical techniques enabling surgeons to perform multiple anastomoses on small vessels easily and safely. Changes in indications have been characterized by a progressive decrease in operations on patients with one-vessel lesions and normal left ventricular function to the benefit of those with multiple-vessel lesions and altered left ventricular function. As a result, the complete revascularization rate and the number of anastomoses have increased continuously. These two categories of changes have not modified the overall in-patient mortality rate, but there has been a significant increase in peri-operative necrosis.