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An 11 year evolution of coronary arterial surgery (1968-1978)
Insights
This study shows that coronary artery bypass grafting outcomes improved over time due to increased surgical experience and technological advancements, leading to better patient survival rates.
Area of Science:
- Cardiovascular Surgery
- Medical Technology Advancement
- Patient Outcomes Research
Background:
- Myocardial revascularization procedures have evolved significantly since the late 1960s.
- Understanding long-term outcomes is crucial for assessing surgical advancements.
Purpose of the Study:
- To compare outcomes of isolated myocardial revascularization between early (1967-1970) and later (1971-1978) surgical eras.
- To identify factors influencing graft patency and patient survival post-procedure.
Main Methods:
- Retrospective analysis of 741 patients (1967-1970) versus 1,000 patients annually (1971-1978) undergoing elective myocardial revascularization.
- Data collected via a computerized cardiovascular information registry.
- Graft patency and five-year survival rates assessed through follow-up and catheterization data.
Main Results:
- Despite an increase in patient age and disease severity, operative mortality decreased slightly.
- Graft patency rates improved, particularly with the introduction of internal mammary artery grafts.
- Five-year survival rates showed significant improvement in later cohorts, with 89.6% to 93.2% survival.
Conclusions:
- Improved surgical techniques, technological innovations (e.g., internal mammary artery grafts), and enhanced patient management contributed to better outcomes.
- Factors like abnormal ventricular function and incomplete revascularization negatively impacted longevity.
- The study highlights the benefits of accumulated surgical experience and evolving medical practices in cardiovascular surgery.
Abstract:
All patients who underwent isolated myocardial revascularization procedures from 1967-70 (n = 741) were compared with the first 1,000 patients who received similar elective operations each year from 1971 through 1978. Data from these eight years were processed through a computerized cardiovascular information registry. Median age increased from 50 to 56 years, multiple-vessel disease increased from 44 to 89%, and left ventricular asynergy from 41 to 54%. The number of grafts per patient increased from 1.5 to 2.5 and yet morbidity declined in every category except neurologic deficit. Operative mortality was 1.1% from 1967 through 1978 and 0.9% from 1971 through 1978. Graft patency was determined for 475 patients from 1967-70, 553 patients from 1971, 519 from 1972, and 540 from 1973. Patency rates after a mean catheterization interval of 21 months were 77, 77, 84, and 87% respectively. Higher graft patency coincides with introduction of the internal mammary artery graft. Five year follow-up was completed for the 1967-1970 series and 1971, 1972, and 1973 cohorts. Actuarial five year survival was 89.6, 91.6, 93.2, and 91.7%. Five year survival comparisons between 1967-1970 patients and 1971-1973 patients in single-, double-, and triplevessel disease categories show significant extended longevity in the later experience. Abnormal ventricular function and incomplete revascularization adversely influenced longevity (p < 0.05) in all years surveyed. In those series the percentage of asymptomatic patients at five years was 66, 65, 69, and 67%. Lower risk and higher five year survival are attributed to greater technical experience, changing technology, and improved management rather than to selection of lower risk cases.