The relationship of patient selection to prognosis following aortocoronary bypass

• Published in: Circulation (New York, N.Y.) N.Y.), 1977-01, Vol.55 (1), p.158-163
• Main Authors: Conley, M J, Wechsler, A S, Anderson, R W, Oldham, H N, Sabiston, D C, Rosati, R A
• Format: Article
• Language: English
• Subjects: Cardiac Catheterization; Coronary Artery Bypass - mortality; Female; Heart Failure - surgery; Humans; Male; Middle Aged; North Carolina; Prognosis
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.55.1.158

Operative mortality for the first 787 patients who underwent aortocoronary bypass at Duke University Medical Center was 9.7%. Within 699 patients who underwent elective bypass only, operative mortality was 8.8% before January 1, 1972, and 5.4% subsequently. This apparent variation in operative mortality over time was largely a consequence of changing patterns of patient selection, i.e., a two- to three-fold decrease in the prevalence of ventricular dysfunction. Since January 1, 1972, operative mortality for 444 patients with mild or no heart failure who underwent elective bypass only was 5.0%. The 55 patients with left main disease had 12.7% operative mortality. In the 192 patients without left main disease who had one- or two-vessel disease, operative mortality was 1.0%, whereas, 197 patients with three-vessel disease had a 6.6% operative mortality. The 103 patients with three-vessel disease less than 50 years of age underwent operation with a 2.9% mortality. Although these results demonstrate that selected patients may undergo operation with a mortality approaching 1%, it is not clear that only such low risk patients should be offered surgery. Accurate estimates of benefits and risks of aortocoronary bypass surgery are necessary in the management of specific patients.