Editorial: Saphenous vein bypass surgery for coronary artery disease

A critical perspective on coronary artery disease and coronary bypass surgery

This paper examines coronary artery disease and coronary artery bypass graft (CABG) surgery from a critical medical anthropological perspective. It explores the issue of why an expensive, individualistic, and mechanistic treatment for the symptoms of coronary artery disease (CABG surgery) has come to be so widely used to treat a condition which is so clearly related to occupational, social and environmental stresses and to behavioral factors. The paper also addresses the issue of why CABG surgery has proliferated in the absence of firm evidence from controlled studies that it is an effective long-term mode of treatment for many patients with this disease. Through this analysis of the growth and continued overuse of CABG surgery the social nature of biomedical knowledge and the socio-cultural, political and economic nature of biomedical decision making are revealed.

Mechanisms of angina relief in patients after coronary artery bypass surgery

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Correlation of heart size with clinical and hemodynamic findings in patients with coronary artery disease

The clinical, hemodynamic, and angiographic findings were correlated with the heart size in 207 patients with proved coronary artery disease. Cardiomegaly was noted in 34 patients and normal heart size in 173. In these two groups, the patients' age range, duration of disease, and history of myocardial infarction were similar. There was no statistical difference in incidence of shortness of breath, hypertension, left ventricular hypertrophy, or abnormal glucose tolerance. Patients with cardiomegaly had a significantly higher incidence of congestive heart failure (26 per cent) as compared to patients with normal heart size (2.9 per cent) (P less than 0.001). Patients with enlarged heart presented a high incidence of anterior wall or multiple myocardial infarction (73 per cent) (P less than 0.001). The cardiomegaly group had a high incidence of elevated end-diastolic volumes, elevated end-diastolic pressures, and diminished ejection fractions when compared to patients with normal heart size (P less than 0.01). Double and triple coronary artery disease was more frequent in patients with cardiomegaly and total coronary score was also higher in this group (P less than 0.005). Asynergy was present in 55 per cent of patients with normal heart size but in 82 per cent of those with enlarged hearts (P less than 0.01). The group of patients with cardiomegaly and documented congestive heart failure had ejection fractions less than 0.30. Cardiac catheterization is probably not advisable in these patients in the absence of associated significant mitral regurgitation, ventricular septal defect, or ventricular aneurysm.

[Coronary heart disease: pathlogy (author's transl)]

The review deals first with the importance of the risk factors for coronary heart disease, the progression of coronary arteriosclerosis and the location of atherosclerotic lesions. The areas of blood supply to the coronary arteries and the effects of coronary insufficiency in the myocardium are discussed. Finally the aneurysm and the morphologic changes in aortocoronary venous bypass are described.

Postoperative changes in aortocoronary saphenous vein grafts revisited: angiographic studies at two weeks and at one year in two series of consecutive patients

Comparison of aortocoronary saphenous vein graft status at two weeks and at one year was made in two series of patients. The early postoperative evaluation includes 122 patients of the first 138 operated in our institution (182 grafts) and 83 subjects from a second series of 100 patients operated after modifications of surgical techniques (184 grafts). The one-year follow-up study was obtained in 105 patients of the first series (154 grafts) and in 67 of the second (152 grafts). The patency rate at two weeks was not significantly different between the two groups: 86.3% vx. 91.8%. A marked decrease of steonses noted early at anastomotic sites was observed: 15% to 5.5% (P less than 0.025). The patency rate at one year improved from 67% to 85,5% (P less than 0.0005). Grafts having flows at operation of at least 50 ml/min had patency rates of 90% in both series. The patency in grafts with initial flows below 50 ml/min increased from 28% to 73% (P less than 0.005). The incidence of late localized graft stenoses greater than 40% decreased from 16.5% to 6% (P less than 0.025), and diffuse narrowing greater than 40% was found in only 12% of the patent grafts at one year in the second series as compared to 31% in the first (P less than 0.001). These improved results do not appear to have been influenced by selection favoring better distal run-off in grafted arteries nor by the introduction of sequential grafts to multiple coronary arteries in the second group. Modified surgical techniques may explain the improved results.

Surgical treatment for stable angina pectoris. Prospective randomized study

To evaluate the role of coronary bypass treatment of stable angina, 72 patients were randomly divided into surgical and medical groups. They were followed with treadmill tests and repeat catheterization. Anginal symptoms decreased or disappeared in 89 per cent of those operated on and 65 per cent of those not operated on, but more of the former than of the latter became asymptomatic: 69 vs. 11 per cent respectively (p smaller than 0.01). Exercise tolerance time improved significantly (p smaller than 0.001) in both groups, but more in the group operated on, plus 78 per cent vs. plus 48 per cent, p smaller than 0.05. During a 28-month follow-up period, fewer cardiac complications occurred in the patients operated on--14 vs. 34 (p smaller than 0.02). Mortality was 9 per cent in the patients operated on and 14 per cent in those not operated on; this difference is not significant. The results indicate that improvement, though demonstrable in both groups, is greater with surgery, and quality of life during the first 28 months is better in patients who are operated on.