Late Results of Direct Myocardial Revascularisation

Summary

The records of the first 200 consecutive patients undergoing coronary artery bypass grafts at Harefield Hospital were analysed. The operative mortality was less than 1% in patients operated on for angina alone, and the late mortality was 1.5%. Relief of symptoms was achieved in 90% of cases. Out of 22 patients with angina and heart failure, there was no operative death and 2 late deaths; relief of angina was achieved in all, however no significant change in heart failure was observed. Sixteen patients were operated on for painless angina, heart failure, or combination of both. heart failure, the operative mortality was 10% and five patients died late, symptomatic improvement was observed in only 4. Reinvestigation at periods of up to 26 months showed that 90% of the grafts were patent with no evidence of progressive narrowing or dilatation. Myocardial blood flow measurement using ¹³³xe showed significant improvement after operation. It is concluded that direct myocardial revascularisation is an effective means of treating patients with ischaemic heart disease and that the results are maintained for up to 4 years. The early and late results depend largely on whether the operation was performed for Direct myocardial revascularisation by coronary artery bypass grafting is now an established clinical procedure (1-3). It is important, however, at this stage of our knowledge to define accurately the results of the operation and compare them to the already known natural history of the disease (4-6). This will enable meaningful evaluation of the procedure and help future patient selction. In this paper the clinical course of the first 200 patients operated on by one of us at Harefield Hospital are analysed. The minimum period of follow up was 6 months. As the object of myocardial revascularisation is to relieve symptoms, improve left ventricular function and enhance survival, an attempt is made to present the results with particular reference to these three parameters.