Some reflections on the coronary bypass operation.

نویسنده

  • W W Glenn
چکیده

SUMMARY A promising new operation-coronary bypass-has been developed for the treatment of coronary heart disease. However, because of the nature of the underlying disease and the minute size of the vessels to be anastomosed, its long-range prospects are in doubt. At this point in time there is no evidence that the operation either prevents infarction or prolongs life, and great caution is urged in applying it, reserving it for those who have life-threatening coronary artery disease, are clearly recalci-trant to optimum medical management, and have apparently nonnal coronary vessels distal to the point of stenosis. There is an urgent need for a better definition of the indications for operation in patients with coronary artery disease based on a study of the natural history of this coindition. Prophylactic operation for patients with a compromised coronary circulation with or without angina must await long-term results of therapeutic operation. I N VIEW OF THE extraordinary interest in the current surgical operation for coronary atheroselerosis, and the great expansion of our medical facilities and training programs to xvhich we would be committed by enthusiastic endorsement of this operation, I believe the time is propitious for an airing of the situation. I feel obligated to present to you evidence that suggests a cautious approach to this operation, while at the same time I acknowledge its successful application to certain patients with life-threatening myocardial ischemia. It is of course not possible to determine precisely the number of patients with coro-nlary heart disease in the United States at this moment, but let us look at some figures. Though grossly approximate at best, they do reveal the magnitude of the case load. In 1967 heart and blood vessel diseases accounted for 54.1% of the deaths in the United States, or just over a million deaths.' Coronary heart disease (CHD) accounted for 57.2% of these, or 573,153 deaths (Code 420 Initernational Classification of Disease, 7th revision), the highest rate in the world probably, except for Finland's.2 According to figures from 1962 (the common reference point in Keys' study), in the 40-59 age group, where at least two thirds of CHD is found, 33.9-42.3%; of deaths in white males were due to the disease (fig. 1).-2 Of the United States sample of 2571 railroad men aged 40-59 years, 25 in the sample, or 1% (a surprisingly smaller percentage than in samples from some of the other countries in this study), …

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method

Background: Lactic acidosis in cardiac surgical patients is a manifestation of systemic inflammation and excess pro-inflammatory cytokine production. This investigation was designed to integrate basic concepts about lactate acidosis with a clinically used of serum lactate in patients under coronary artery bypass surgery (CABG) by on pump method. Methods: From August to September 2012, 15 patie...

متن کامل

A comparison of laboratory findings in coronary artery bypass surgery with and without cardiopulmonary bypass

Background : Quests for doing coronary artery bypass surgery by a technique with lower complications is going on, for this aim many studies compared patients undergoing CABG with or without cardiopulmonary bypass. This study was carried out to compare laboratory findings after coronary artery bypass in these two groups of patients. Materials and Methods: In a retrospective study, 167 patients ...

متن کامل

Comparison of the Graft Angles Effects on the Temporal Wall Shear Stress Gradients in the Aorto-Coronary and Coronary-Coronary Bypasses

In this theoretical study, the effect of various types of bypass graft angles on the flow field, has been investigated specially on the temporal Wall Shear Stress (WSS) on the toe, heel and some locations on the bed of the Left Anterior Descending (LAD) artery at the anastomoses areas in the Aorto-Coronary (AC) and Coronary-Coronary (CC) bypasses. Flow fields in both bypasses with angles of...

متن کامل

بررسی تغییرات اودیومتریک بعد از بای- پس شریان کرونر

Background: Hearing is one of the most significant senses There fore, any defect can be frightening. The incidence of sever hearing loss following coronary artery bypass surgery has been estimated as one per thousand. This Prospective study carried out to determine hearing effects of coronary artery bypass surgery.Methods: age, audiometric changes before and after surgery (hearing levels at mul...

متن کامل

Effect of coronary artery bypass on QT dispersion

Introduction: QT dispersion (QT Max – QT min) reflects inhomogeneous ventricular depolarization that may provide a substrate for serious arrythmias and is associated with adverse clinical outcomes in patients with coronary artery disease. Some studies have shown reduction in QT dispersion after successful angioplasty due to coronary reperfusion, but effect of coronary artery bypass grafting o...

متن کامل

Management of Catheter Induced Upper Limb Suppurative Thrombophlebitis in a Patient after Coronary Artery Bypass Graft Surgery: a Case Report

Introduction: One of the important complications of peripheral venous catheters is suppurative thrombophlebitis that would be life threatening without treatment. In this report, we introduce a patient who developed purulent thrombophlebitis due to venous catheter in the upper limb after coronary artery bypass graft surgery. Multiple abscess formation was developed on her upper limb after the th...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Circulation

دوره 45 4  شماره 

صفحات  -

تاریخ انتشار 1972