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[Long-term result of aorto-coronary bypass surgery]
Insights
Aorto-coronary bypass surgery demonstrates favorable outcomes for ischemic heart disease. This review of 419 cases highlights low mortality rates and good survival, confirming its safety and efficacy.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Ischemic Heart Disease Treatment
Context:
- Review of 419 aorto-coronary bypass surgeries over 8 years at Juntendo University Hospital.
- Analysis focused on operative, hospital, and late mortality, alongside survival rates.
- Evaluation of factors influencing surgical outcomes, including patient demographics and preoperative conditions.
Purpose:
- To assess the safety and efficacy of aorto-coronary bypass surgery for ischemic heart disease.
- To identify predictors of mortality and survival in patients undergoing bypass surgery.
- To evaluate the impact of intraoperative myocardial protection strategies on surgical results.
Summary:
- Isolated coronary bypass surgery showed a 2.7% operative mortality and 94.1% survival rate.
- Higher mortality was observed in patients with left main trunk lesions, those over 60, and with unstable angina.
- Intraoperative myocardial protection, particularly with lidocaine, aprotinin, and coenzyme Q10, improved results, especially for high-risk patients.
Impact:
- Aorto-coronary bypass surgery is confirmed as a safe and crucial treatment for ischemic heart disease.
- Findings provide valuable data for risk stratification and patient selection in bypass surgery.
- Highlights the importance of myocardial protection in optimizing surgical outcomes and patient survival.
Abstract:
Four hundred and nineteen cases of aorto-coronary bypass surgery which were operated at the Juntendo University Hospital for last 8 years were reviewed with respect to operative, hospital and late mortality, and survival. Isolated coronary bypass (371 pts) had 2.7 per cent of operative mortality, 1.9 per cent of hospital mortality, 1.3 per cent of late mortality and 94.1 per cent of survival rate postoperative follow-up ranged up to 8 years (average 3.51 years). Late mortality was 2.6 per cent in the group of left main trunk lesion, 1.3 per cent in the group of patients over 60 years old, 0.7 per cent in single bypass group, 1.2 per cent in double bypass and 6.7 per cent in triple bypass group. Patients complaining of unstable angina showed significantly higher operative, hospital and late mortality compared with patients with stable angina. Cardioplegia for an intraoperative myocardial protection provided better operative result, however, there is no significant difference in late mortality between potassium-induced and potassium-magnesium-induced cardioplegia. Intraoperative myocardial protection using lidocaine, aprotinin and coenzyme Q10 is important to improve surgical results in patients with either left main trunk lesion or age over 60. Successful treatment of 5 patients with evolving or acute myocardial infarction was experienced. These results suggest that aorto-coronary bypass surgery is accepted as a safe and important treatment for ischemic heart disease.