Surgical treatment of coronary artery disease: pure graft operations, with a study of 741 patients followed 3--7 yr.

This report reviews the experience with bypass graft surgery in the pure form, without associated cardiac procedures, in 6828 patients operated upon from 1967 through 1974. The hospital mortality rate in this group was 1.4%. The incidence of definite perioperative myocardial infarction was 6.9% prior to 1971, and 4.1% in the past 3 yr. Graft patency in postoperative studies performed an average of over 12 mo after surgery was 83.6%, and 89% of patients had one or more functioning grafts. In a subgroup of 741 consecutive patients operated upon with pure graft techniques from 1967 through 1970, survival seemed to be improved when compared to another group of similar, but nonoperated patients. The average annual mortality rate was 3.3% per yr in the surgical group (including surgical mortality) compared to 8.8% per year in the medical group. Differences in survival were most striking in patients with isolated anterior descending, double and triple vessel involvement. In the 741-patient subgroup the incidence of new occlusions of grafted arteries was related to the severity of the lesion(s) for which the operation was performed, and unrelated to graft patency. Arteriographically demonstrated new occlusions of ungrafted arteries were infrequent, and few patients developed significant new lesions during the period of observation. Symptomatic improvement is related to completeness of revascularization as determined by postoperative arteriography.