Are There Indications for Surgery in Asymptomatic Patients?

  • A. Selzer
Conference paper

Abstract

In every form of treatment, be it medical or surgical, it is neces­sary to evaluate the risk-benefit relationship. The performance of aortocoronary bypass operation in patients who are free from symp­toms, apparently in good health, requires a particularly careful analysis of factors involved because the operation is primarily of prophylactic nature, that is, aimed at prevention of future problems. Justification for the performance of a major heart operation in an apparently well subject rests upon four assumptions:
  1. 1.

    Stenotic lesions in coronary arteries are inevitably and rapidly progressive.

     
  2. 2.

    As a corollary of the previous statement, patients with signifi­cant stenotic lesions are always at the high risk of acute myo­cardial infarction or sudden death.

     
  3. 3.

    Bypass operations successfully and reliably protect the patient from these disastrous events.

     
  4. 4.

    Clinical symptoms are unreliable as guidelines to myocardial ischemia.

     

Keywords

Depression Ischemia Luminal Cardiol Bursitis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Vlodaver, Z., Edwards, J.E.: Pathology of coronary atherosclerosis. Prog. Cardiovasc. Dis. 14, 256 (1971)PubMedCrossRefGoogle Scholar
  2. 2.
    McGregor, M.: The coronary collateral circulation: A significant compensatory mechanism or a functionless quirk of nature. Circulation 52, 529 (1975)PubMedGoogle Scholar
  3. 3.
    Pasternak, R., Cohn, K., Selzer, A., Langston, M.F. (Jr.): Enhanced rate of progression of coronary artery disease following aortocoronary saphenous vein bypass surgery. Am. J. Med. 58, 166 (1975)PubMedCrossRefGoogle Scholar
  4. 4.
    Murphy, M.L. Hultgren, H.N., Detre, K., Thomsen, J., Takaro, T., et al: Treatment of chronic stable angina. N. Engl. J. Med. 297, 621 (1977)PubMedCrossRefGoogle Scholar
  5. 5.
    Hutter, A.M., Russel, R.O. (Jr.), Resnekov, L., Wölk, M., Rosati, R.A., Conti, C.R., Becker, L., Biddle, T., Schroeder, J.S., Kaplan, E.M., Gilbert, J.P., Mock, M.B.: Unstable angina pectoris. National randomized study of surgical vs. medical therapy: Results in 1, 2 and 3 vessel disease. Circulation55–56 [Suppl.III], 60 (1977) (Abs.)Google Scholar
  6. 6.
    Selzer, A., Cohn, K.: Asymptomatic coronary artery disease and coronary bypass surgery. Am. J. Cardiol. 39, 614 (1977)PubMedCrossRefGoogle Scholar
  7. 7.
    Vlietsra, R.D.E., Assad-Morell, J.L., Frye, R., Elveback, L.R., Connoly, D.C., Ritman, E.I;, Pluth, J.R., Barnhorst, D.A., Danielson, G.K., Wallace, R.B.: Survival predictors in coronary artery disease. Medical and surgical comparisons. Mayo Clin. Proc. 52, 85 (1977)Google Scholar
  8. 8.
    Gross, H., Vaid, A.K., Cohen, M.V.: Prognosis in patients rejected for coronary revascularization surgery. Am. J. Med. 64, 9 (1978)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Verlag Berlin Heidelberg 1979

Authors and Affiliations

  • A. Selzer

There are no affiliations available

Personalised recommendations