Coronary bypass surgery. Five-year follow-up of a consecutive series of 140 patients.

Abstract

The 5 year follow-up of a consecutive series of 140 patients who underwent coronary bypass surgery from January through December of 1972 is reported. No patient was lost to follow-up. Indications for operation were stable angina in 76 patients, unstable angina in 62 patients, and intractable arrhythmia in two patients. Twenty patients had single grafts, 49 double grafts, 58 triple grafts, 12 quadruple grafts, and one quintuple graft. Of the 345 grafts, 132 were mammary arteries, 212 were saphenous veins, and one was a splenic artery. Saphenous veins were removed from below the knee and were 2.5 to 4.0 mm. in diameter. Arteriotomies and anastomoses were performed with high magnification. Five years after operation 93 patients (70 or 71 percent of survivors) had had no recurrence of angina and 38 (29 percent) had experienced at least one episode of angina. Thirty of these patients considered the angina to be less severe than before the operation, six considered it to be the same, and one considered it to be more severe. Angiograms were performed in the late postoperative period in 32 patients, of whom 19 had had recurrent angina. The patency rate of vein grafts was 83 percent and that of mammary artery grafts, 92 percent. Selective injections of radioactive xenon showed resting and hyperemic mammary artery flows to be the same as flows through normal coronary arteries. There were two hospital deaths and seven late deaths. Two of the late deaths were due to cancer and five to cardiac disease. Cardiac-related deaths occurred 3 months (one), 3 years (two), 4 years (one), and 5 years (one) after operation. Five years after operation, 131 of the 140 patients were alive. The 5 year survival rate of this surgically treated group (94 percent) exceeds that of any medically treated group ever reported.