[The aorto-coronary by-pass. Personal clinical experience (author's transl)]

The surgical treatment of coronary artery disease still remains controversial, despite the fact that the surgical indications are widely recognized and so the efficacy of the aortocoronary bypass in relieving angina and in improving the prognosis of the patients with left mainstem lesions. However, one gets the impression that the criteria for surgery not always are correctly applied, with the consequence that the bypass is often performed on patients that could still benefit from proper medical treatment. At Groote Schuur Hospital, during the period 1976-78, we have bypassed a total of 395 coronary arteries in 204 patients. All the patients were in NYHA class III and IV. The peculiarity of this rather small series is based on the conservatism of the selection criteria, the operation being offered only to candidates with a very long history of angina uncontrolled by adequate medical treatment. The early mortality rate has been 1.47%, the late mortality rate 3.5% and the perioperative infarction rate 10.8%. All the patients have been followed up for 12-48 months (mean follow up 30.3 months). 80% of the patients returned in class I and 13.5% in class II. 80 out of 112 patients operated during 1976-77 have had routine coronary angiography one year post-surgery: the graft patency rate in this group has been 71%. The majority of the obstructed grafts were related to small vessels of 1 mm in diameter. On the basis of these clinical results we conclude that no controversy is justified once and adequate trial with proper medical treatment has already failed.