Saphenous vein bypass surgery for coronary artery disease
| Autor: | Moosa Najmi, William Likoff, Bernard L. Segal, Joseph W. Linhart |
|---|---|
| Rok vydání: | 1973 |
| Předmět: |
medicine.medical_specialty
business.industry Mortality rate Cardiogenic shock Ischemia Infarction Anastomosis medicine.disease Surgery Coronary artery disease medicine.anatomical_structure Internal medicine medicine Cardiology Myocardial infarction Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | The American Journal of Cardiology. 32:1010-1013 |
| ISSN: | 0002-9149 |
| Popis: | may be entirely normal in the absence of stress; "Con sequently, exercise or atrial pacing has been used in our laboratory in the preoperative evaluation. Al· though exercise stress appears to be a sensitive crite rion, it is contraindicated in the presence of the "preinfarction syndrome"; hence, such studies are not performed in patients with this syndrome. Low surgical mortality rates in many reported studies reflect the selection of low risk patients with good ventricular function. In our experience with more than 500 patients, the mortality rate for the group with poor left ventricular function was ap proximately 15 percent. Surgical mortality is also greater in patients with triple vessel disease than in those with single vessel disease. 4 It has been re ported 4 that the hospital mortality is slightly greater in those with double and triple vessel disease than in those with single bypass. These statistics are even more meaningful if the surgeon is not able to bypass an obstructed coronary artery. Patients who were subjected to an incomplete procedure wherein all the obstructed vessels could not be adequately bypaflsed did poorly after surgery. An anastomosis inadequate because of technical problems or severe distal ath erosclerosis permits continuing ischemia, and the operative and postoperative risk is thereby greatly increased. The number of operative deaths among patients with impending myocardial infarction varies consid erably, ranging from a to 19 percent. 5-8 These dispa rate results represent various methods of selecting patients. Apparently, these groups of patients are not homogeneous, and the risk and prognosis vary considerably. The physician at the bedside is not al ways able to differentiate preinfarction from the e volving infarction syndrome. We believe the mortality to be much greater in patients with evolving infarc tion and therefore do not recommend the operation at that particular time. What is the operative morbidity? Complications at the time of operation and during the immediate postoperative period include ventricular failure and cardiogenic shock due to prolonged pump time, myo |
| Databáze: | OpenAIRE |
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