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[Aortocoronary bypass with 10 years' follow-up. Apropos of 183 cases]
Insights
This study on coronary artery bypass surgery found excellent long-term symptom relief and comparable survival rates. Patients with multi-vessel disease may benefit significantly from this intervention.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Saphenous vein aorto-coronary bypass surgery was performed on 183 patients between 1970-1972.
- Preoperative conditions included invalidating angina (100%), unstable angina (12%), and previous myocardial infarction (61%).
- Prevalence of coronary artery disease: 64.5% triple vessel, 18.6% double vessel, 14.2% single vessel.
Purpose of the Study:
- To evaluate the long-term efficacy and outcomes of saphenous vein aorto-coronary bypass surgery.
- To assess symptom relief, survival rates, graft patency, and return to work over a 10-year period.
Main Methods:
- A 10-year follow-up study involving patient and cardiologist questionnaires.
- Analysis of perioperative data, including grafts performed (1.8/patient), endarteriectomies, and complete revascularization rates (52%).
- Assessment of perioperative infarction (17.5%), operative mortality (7.6%), and 10-year cardiovascular mortality.
Main Results:
- 10-year actuarial survival rate was 66%, with 11 cardiovascular deaths.
- Half of the patients were asymptomatic, and two-thirds required no anti-anginal therapy.
- Graft patency was 72.8% at one year; two-thirds returned to full-time work within a year.
Conclusions:
- Coronary artery bypass surgery demonstrates excellent long-term symptomatic improvement.
- Survival and infarction rates are comparable to existing literature.
- Patients with triple or double vessel disease may experience improved longevity compared to medical management.
Abstract:
Between 1970 and 1972, 183 patients were admitted to the CMC Foch (Pr D. Guilmet) for saphenous vein aorto-coronary bypass surgery. Ten years later a questionnaire was sent to the patient and his cardiologist and the two replies were analysed. Before surgery, all patients had invalidating angina: 12 p. 100 had unstable angina, 61 p. 100 had previous myocardial infarction. Preoperative coronary angiography showed triple vessel disease in 64,5 p. 100, double vessel disease in 18,6 p. 100 and single vessel disease in 14,2 p. 100. There hundred and thirty two grafts were performed (average 1,8 per patient); 42 endarteriectomies were also carried out, 35 on the right coronary artery. Complete revascularisation was achieved in 95 cases (52 p. 100). The incidence of perioperative infarction was 17,5 p. 100 and operative mortality was 7,6 p. 100. Thirty two patients (19 p. 100) died during the 10 year study period; 11 deaths were of cardiovascular origin. The 10 year actuarial survival rate was 66 p. 100. Half the patients are asymptomatic and nearly two thirds take no anti-anginal therapy. The patency of the grafts was chacked in about half the cases and was found to be 72,8 p. 100 at one year. From the professional point of view, two thirds of patients returned to full time working one year after surgery. The degree of activity at 10 years is only known in 87 cases; half these patients are working and a quarter have retired normally. This study shows that: --coronary bypass surgery has excellent long-term effects on symptoms; --the incidence of infarction and survival are comparable to other reported studies; --patients with triple or double vessel disease may have lived longer after surgery than had they been treated medically.