Surgical treatment of atherosclerotic heart disease.

Because the surgical mortality rate in patients older than age 70 years is significantly higher than that of patients aged 50 to 60 years, surgical treatment of atherosclerosis in the elderly should be used after medical measures have failed. Balloon angioplasty is the surgical treatment of choice, but coronary artery bypass may be performed when necessary. In most patients older than 65 years, the rate of progression of atherosclerosis is slow, and additional surgical treatment may not be required for many years. In the elderly, atherosclerosis is often found in more than 1 of the 4 major arterial beds. About 15% of patients with coronary artery disease requiring operation have atherosclerosis in a second major arterial bed. Previously unpublished data on risk factors and survival rates in patients who have undergone coronary artery bypass surgery are reviewed.