HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Reoperation for coronary atherosclerosis. Changing practice in 2509 consecutive patients.

Abstract
We analyzed trends in clinical, angiographic, and operative variables and documented long-term survival in 2509 consecutive patients who underwent reoperation for myocardial revascularization at The Cleveland Clinic during a 20-year period (1967 to 1987). The patients were grouped into four cohorts by year of surgery. This analysis showed that vein graft atherosclerosis has become the leading indication for reoperation, and patient age and interval between operations continue to increase. Mortality rates ranged from 2% to 5% and, despite increasing comorbidity, more extensive coronary atherosclerosis, and worse left ventricular function, the hospital mortality rate was 2.9% from 1985 to 1987. Perioperative new Q-wave myocardial infarction occurred in 7% to 8% of patients from 1967 to 1984 but decreased to 4% in the 1985 to 1987 period (p = 0.04). Internal thoracic artery graft usage in reoperations increased from 27% in the 1967 to 1978 period to 67% in the 1985 to 1987 period. Advanced age and presence of left main coronary artery disease adversely influenced late survival more consistently than other factors. Patients operated on in 1967 to 1978 had fewer risk factors, which explains their higher survival rate compared with more recent cohorts. Factors associated with improved 10-year actuarial survival included age younger than 65 years, mild angina, no major comorbidity, no left main coronary artery disease, good left ventricular performance, and an internal thoracic artery graft.
AuthorsF D Loop, B W Lytle, D M Cosgrove, E L Woods, R W Stewart, L A Golding, M Goormastic, P C Taylor
JournalAnnals of surgery (Ann Surg) Vol. 212 Issue 3 Pg. 378-85; discussion 385-6 (Sep 1990) ISSN: 0003-4932 [Print] United States
PMID2396889 (Publication Type: Journal Article)
Topics
  • Coronary Artery Disease (mortality, physiopathology, surgery)
  • Electrocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Reoperation
  • Risk Factors
  • Survival Rate

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: