Coronary bypass grafting in 476 patients consecutively operated on.

The results of coronary bypass grafting procedures were reviewed in 476 patients consecutively operated on. The operative mortality was lowered from 7 percent in the 6rst 100 patients to 0.8 percent in the remaining 376 patients. A comprehensive and detailed evaluation was performed by cardiologists in 122 patients operated upon early in the series and followed for more than 18 months. A n g i i was totally relieved or improved in 89 percent of patients. Four patients out of 122 had sustained new myocardial infarctions during the follow-up period. Eighty-two percent of patients were rehabilitated to return to their usual gainful employment or their usual mode of life. C oronary bypass grafting is now recognized by many as the therapeutic procedure of choice for selected patients with atherosclerotic heart disease. In general, patients with anginal syndromes and hemodynamically significant proximal or mid blocks of one or more of the major coronary arteries and fair left ventricular contractility are considered candidates for operation. Increased experience with patient selection and improvements in the technical aspects of the operations have lowered the operative mortality and morbidity progressively at our institution. Recently, when reviewing results with coronary bypass grafting procedures, we noted that seven operative deaths occurred in our first 100 patients but only three mortalities occurred in the last 376 patients consecutively operated on (October, 1971, to September 1, 1972) who had coronary bypass grafts alone performed. The factors which we think account for the lowered mortality are reviewed as well as longterm follow-up results. performed at outside facilities and were referred to St. Luke's Hospital Center for operation. The other half had catheter-ization studies performed at St. Luke's Hospital. The indications for operation were the presence of an anginal syndrome, a history of one or more major myocardial infarctions with persistent angina, and rarely ventricular dysrhythmias ascribed to myocardial ischemia. All patients operated upon in this series had anginal syndromes of some variety. Patients with preinfarctional angina as characterized by accelerated and prolonged angina at rest, an unstable electrocardiogram and normal serum enzyme determinations, were operated upon on an emergency basis. Thirty patients in this series fulfilled these criteria. When there was electrocardiographic or enzyme evidence of definite transmural infarction, operation was not performed and the patients were treated medically. Patients were selected for operation if good quality selective cine angiography indicated significant proximal obstructions in one or more of the …