Bypass surgery for chronic stable angina: predictors of survival benefit and strategy for patient selection

Article Abstract:

One treatment for chronic stable angina (severe chest pain that follows a stable pattern) is coronary artery bypass grafting (CABG), in which a blocked coronary artery is 'bypassed' by a grafted vessel. However, this is not the best treatment for all patients with chronic stable angina and, since the surgery itself is associated with complications and mortality, determining which patients will benefit is of great importance. Five major studies (none of which included a cross-section of the population with coronary artery disease) were evaluated and the results pooled to address the issue of who is best served by CABG. Patients with impaired left ventricular function (decreased pumping by the heart) have poor survival when treated only with drugs; in these cases, CABG improves survival considerably. People with the highest number of blockages or with blockages in the most important coronary arteries tend to derive the greatest survival benefit from CABG. The more significant the angina, the more likely the patient will experience benefit from CABG. Older patients seem more likely to benefit from CABG, until about the age of 75, after which the mortality from surgery outweighs the benefits of the procedure. Only one study included women, who have nearly twice the death rate of men from heart attacks. They also have a greater operative mortality after CABG, but those who survive CABG surgery have a far better prognosis than women with significant disease who do not undergo CABG. Patients with abnormal electrocardiograms and abnormal exercise stress test results also derive survival benefit from CABG. The decision to proceed with CABG surgery is generally based on the results of coronary catheterization (dye studies to determine the degree of blockage in the coronary arteries). The criteria that determine whether patients may benefit from surgery are also good guidelines for deciding which patients are the best candidates for catheterization. Studies are still underway to determine patient suitability for CABG, and clinical judgment must always be exercised. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Angina pectoris

---

Coronary artery bypass graft disease

Article Abstract:

Mammary arteries may be a better choice as replacement vessels than leg veins for heart bypass surgery. Heart bypass surgery involves removing a vein or artery from another part of the body and surgically inserting, or grafting, it in place of a damaged heart vessel. Researchers reviewed the current literature on the effectiveness and possible complications in using leg veins and mammary arteries as replacement vessels in heart bypass surgery. Studies have found that 10 years following bypass surgery, 50% of the replacement leg veins closed due to buildup of deposits on the vessel wall while 90% of the replacement mammary arteries remained open. Survival rates at 10 years following single-vessel bypass surgery are 93% for patients with a mammary artery graft and 88% for those with a leg vein graft. Mammary arteries are, however, more technically difficult to remove and are less readily available.

---

Noncardiac surgery in the cardiac patient: what is the question?

Article Abstract:

Specialized heart condition testing before non-heart surgery may be unnecessary except for in high-risk patients with a history of heart disease. Among a group of 1487 men with heart disease, only 4.1% of the patients identified as high risk had a heart attack following non-heart surgery. Patients with heart conditions that are susceptible to vessel rupture should receive thorough testing before considering any major surgery. Doctors should minimize stress on a patient's heart following major surgery in patients with manageable heart conditions but probably do not need to perform extensive and specialized heart tests on these patients before surgery.

Usage, Diagnosis, Coronary heart disease, Preoperative care, Diagnosis, Noninvasive, Noninvasive diagnosis

Similar abstracts:

• Abstracts: Measles prophylaxis for international travel. Global eradication of poliomyelitis and measles: another quiet revolution
• Abstracts: Spotlight on lasers: a look at potential benefits. New and emerging technologies: promise, achievement and deception
• Abstracts: Serologic testing after therapy for syphilis: Is there a test for cure? Serologic response to treatment of infectious syphilis

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.