Reconstructive Coronary Artery Surgery: Postoperative Assessment

Abstract

Results of 288 direct coronary artery reconstructive operations in 281 patients have been reported. Selected patients with segmental obstructive lesions in their coronary arteries can be helped with direct reconstructive surgery. Best results have been achieved in patients with isolated segmental obstructions in the predominant right coronary artery. With the saphenous vein graft technique, surgical mortality has been reduced to 5.1%, and angiographic evidence of improvement has been achieved in three of four of the survivors. The direct surgical reconstruction of segmental occlusive disease offers the advantage of immediate improvement of myocardial perfusion, attendant protection against myocardial infarction, and immediate improvement if not complete remission of symptoms of myocardial ischemia. Excellent long-term results have been obtained in many patients who underwent patch-graft reconstruction; early experience indicates that saphenous vein graft reconstruction can be accomplished for patients with a greater variety of obstructive lesions, with better reliability, and lower risk. Its ultimate role in the surgical treatment of coronary atherosclerosis, however, will require a longer period of observation.