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The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 673-684, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DM Cosgrove, FD Loop, BW Lytle, R Baillot, CC Gill, LA Golding, PC Taylor and M Goormastic
From 1970 to 1982, 24,672 patients underwent primary isolated myocardial
revascularization: Group I, 4,517 patients operated upon from 1970 to 1973;
Group II, 6,181 patients from 1974 to 1976; Group III, 6,869 patients from
1977 to 1979; and Group IV, 7,105 patients from 1980 to 1982. Operative
mortality was 1.2% for the entire experience and 1.2%, 1.4%, 1.6%, and 0.8%
for Groups I to IV, respectively. Mortality for Group IV was significantly
lower (p less than 0.001). In decreasing order of significance, the risk
factors were emergency operation, congestive heart failure, left main
disease, female gender, history of congestive heart failure, advancing age,
normothermic arrest, number of grafts, poor ventricular function, and
incomplete revascularization. The same analysis of Groups I to IV
demonstrated that advanced age, emergency operation, female gender, and
congestive heart failure persisted as risk factors while incomplete
revascularization and abnormal electrocardiogram emerged as new risk
factors. Cardiac causes accounted for 203 (66.2%) patient deaths. This
gradually decreased from 75.3% in Group II to 58.5% in Group IV.
Neurological deficit was the second most frequent cause of death, 29
(9.6%), reaching a high in Group IV (18.9%). We conclude that (1) morbidity
and mortality have decreased significantly despite increasing risk factors;
(2) congestive heart failure has replaced emergency operation as the
principal risk factor; (3) left main disease, number of grafts, and poor
ventricular function have been neutralized as risk factors; and (4) cardiac
causes of death are decreasing and being replaced by other system failure.
ARTICLES
Primary myocardial revascularization. Trends in surgical mortality
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T. J. Gardner, P. J. Horneffer, T. A. Manolio, T. A. Pearson, V. L. Gott, W. A. Baumgartner, A. M. Borkon, L. Watkins Jr., and B. A. Reitz Stroke Following Coronary Artery Bypass Grafting: A Ten-Year Study Ann. Thorac. Surg., December 1, 1985; 40(6): 574 - 581. [Abstract] [PDF]
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R. G. Baillot, F. D. Loop, D. M. Cosgrove, and B. W. Lytle Reoperation after Previous Grafting with the Internal Mammary Artery: Technique and Early Results Ann. Thorac. Surg., September 1, 1985; 40(3): 271 - 273. [Abstract] [PDF]
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