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Interventions for coronary stenosis--a Canadian experience of 30 revolutionary years
G M FitzGibbon1, H P Kafka, A J Leach
1Cardio-Pulmonary Unit, National Defence Medical Centre, Ottawa, Ontario.
Insights
This study reviews 2324 coronary stenosis interventions, including Vineberg procedures, CABG, and PTCA, performed between 1965-1995. It details the evolution and outcomes of these cardiac procedures over three decades.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical History
Background:
- Coronary stenosis interventions have evolved significantly over time.
- Understanding the historical context and comparative outcomes of different procedures is crucial for modern practice.
Purpose of the Study:
- To analyze 2324 coronary stenosis interventions (Vineberg procedures, CABG, PTCA) in 1711 patients from 1965-1995.
- To examine the evolution and interaction of these interventions within a historical framework.
- To report on patient demographics, procedural types, and outcomes.
Main Methods:
- Retrospective review of clinical and angiographic data from patient records.
- Data collected over 30 years and embedded in a custom computer database.
- Analysis of 160 Vineberg procedures, 1637 CABGs, and 527 PTCAs.
Main Results:
- Perioperative mortality rates varied: 4.4% for VbP, 1.4% for isolated first CABG, 6.6% for reoperative CABG, and 0.4% for PTCA.
- Overall perioperative mortality for isolated coronary interventions was 2.4%.
- High angiographic follow-up rates provided data on graft patency and disease progression.
Conclusions:
- Different interventions were employed based on clinical needs and procedural availability over time.
- Advances in surgical techniques and interventional cardiology influenced therapeutic decisions.
- The study acknowledges contributions to the development of these life-saving procedures.
Objective:
To report 2324 coronary stenosis interventions (Vineberg procedures [VbP], coronary artery bypass graft operations [CABG] and percutaneous transluminal coronary angioplasties [PTCA]), in 1711 patients of a Canadian military hospital between 1965 and 1995 and to report their evolution and interaction in a historical context.
Design:
Retrospective examination of clinical and angiographic findings in hard records, collected from the beginning for long term follow-up and later embedded in a custom-designed computer database.
Patients:
Most were male, mean ages 43.2 and 43.3 years for first and second VbPs; 48.9 and 58.2 years for first and repeat CABGs; and 53.4 and 59.9 years for first and repeat PTCAs, respectively; 12% of all patients were 39 years old or younger at the first intervention.
Interventions:
There were 160 VbPs, 1637 CABGs and 527 PTCAs. Of 1711 subjects, 74% had only one procedure, 15% had more than one of the same kind, and 11% had more than one of different kinds.
Main Results:
Perioperative mortality for VbPs was 4.4%; for 'isolated' first CABGs it was 1.4% and 6.6% for reoperations, when other concurrent major cardiac procedures, excepting ventricular aneurysm repair, were excluded. It was 0.4% for PTCAs. Perioperative mortality for all 1761 'isolated' coronary interventions necessitating thoracotomy, during 30 years, was 2.4%. Angiographic follow-up rates were high and some findings are reported, including early postoperative patency rates for 5065 coronary bypass grafts, and long term follow-up data on graft patency and disease.
Conclusions:
Each intervention was used to circumvent or relieve coronary stenosis, in the early years when it became available and, later, as was most appropriate for dealing with specific clinical problems. The impact of advances in the evolution of these interventions on therapeutic decision-making is discussed. Finally, tributes are paid to those responsible for making these procedures possible, including a Canadian surgeon whose role was pivotal.