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Ergebnisse der koronaren Bypasschirurgie

  • B. Schorn
  • Ch. Schucht
  • H. Dalichau
Conference paper
Part of the Deutsche Gesellschaft für Chirurgie book series (DTGESCHIR, volume 1994)

Zusammenfassung

Die rasanten Entwicklungen auf dem Gebiet der interventionellen Kardiologie haben in den letzten Jahren zu einer Zunahme des Anteiles von Patienten höheren Alters, mit schlechterer linksventrikulärer Funktion, mit diffuserem Gefäßbefall sowie zu einer relativen Zunahme von Notoperationen in der koronaren Bypasschirurgie geführt. Der zusätzliche Anstieg des Anteiles an Reoperationen bedingte insgesamt eine ungünstige Änderung des Risikoprofiles. Die Operationsletalität hängt demnach wesentlich davon ab, ob es sich um einen elektiven Eingriff (1–3,4%), um eine Reoperation (3–12%), um einen Notfalleingriff (3–13%; Infarktrate 20–60%) oder um eine Operation bei Patienten mit stark eingeschränkter linksventrikulärer Funktion (5–11%) handelt. Die Langzeitergebnisse nach chirurgischer Myokardrevaskularisation werden durch Verwendung der Arteria thoracica interna bezüglich Überlebensraten, Bypassverschlußraten und Reoperationsraten günstig beeinflußt.

Schlüsselwörter

Koronare Bypasschirurgie Letalität Morbidität Risikoprofil 

Results of Coronary Bypass Surgery

Summary

Due to rapid developments in the field of interventional cardiology, the risk profile of patients undergoing coronary bypass surgery has changed over the past few years. There is an increasing number of patients with advanced age, poor left ventricular function, and more diffuse coronary artery disease, and the proportion of urgent and emergency operations and reoperations has increased continuously. Today, operative mortality is 1% –3.4% in elective procedures. Reoperations (3%–12%), emergency procedures (3%–13%; infarction rate 20%–60%), and interventions in patients with severely impaired left ventricular function (5%–11%), however, carry a significant higher risk. With the use of the internal thoracic artery improvements concerning longterm bypass patency, event-free long-term survival and a decrease in reoperation rates can be achieved when compared with revascularizations using vein grafts only.

Key words

Coronary bypass surgery Mortality Morbidity Risk profile 

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Literatur

  1. 1.
    Acinapura AJ, Jacobowitz IJ, Kramer MD, Zisbrod Z, Cunningham JN (1992) Internal mammary artery bypass: thirteen years of experience. Influence of angina and survival in 5125 patients. J Cardiovasc Surg Torino 33:554–559PubMedGoogle Scholar
  2. 2.
    Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, Levine F, Schloss M (1983) Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation 68:785–795PubMedCrossRefGoogle Scholar
  3. 3.
    Borkon AM, Failing TL, Piehler JM, Killen DA, Hoskins ML, Reed WA (1992) Risk analysis of operative intervention for failed coronary angioplasty. Ann Thorac Surg 54:884–890PubMedCrossRefGoogle Scholar
  4. 4.
    Christakis GT, Weisel RD, Fremes SE, Ivanov J, David TE, Goldman BS, Salerno TA (1992) Coronary artery bypass grafting in patients with poor ventricular function. J Thorac Cardiovasc Surg 103:1083–1091PubMedGoogle Scholar
  5. 5.
    Clark RE (1994) The Society of Thoracic Surgeons National Database status report. Ann Thorac Surg 57:20–26PubMedCrossRefGoogle Scholar
  6. 6.
    Connor AR, Vlietstra RE, Schaff HV, Ilstrup DM, Orszulak TA (1988) Early and late results of coronary artery bypass after failed angioplasty. Actuarial analysis of late cardiac events and comparison with initially successful angioplasty. J Thorac Cardiovasc Surg 96:191–197PubMedGoogle Scholar
  7. 7.
    Cosgrove DM, Loop FD, Lytle BW, Gill CC, Golding LA, Gibson C, Stewart RW, Taylor PC, Goormastic M (1986) Predictors of reoperation after myocardial revascularization. J Thorac Cardiovasc Surg 92:811–821PubMedGoogle Scholar
  8. 8.
    Craver JM, Weintraub WS, Jones EL, Guyton RA, Hatcher CR (1992) Emergency coronary artery bypass surgery for failed percutaneous coronary angioplasty. A 10–year experience. Ann Surg 215:425–433PubMedCrossRefGoogle Scholar
  9. 9.
    de Feyter PJ, den Brand M, Laarman GJ, van Domburg R, Serruys PW, Suryapranata H (1991) Acute coronary artery occlusion during and after percutaneous transluminal coronary angioplasty. Frequency, prediction, clinical course, management, and follow-up. Circulation 83:927–936PubMedCrossRefGoogle Scholar
  10. 10.
    Disch DL, O’Connor GT, Birkmeyer JD, Olmstead EM, Levy DG, Plume SK (1994) Changes in patients undergoing coronary artery bypass grafting: 1987–1990. Ann Thorac Surg 57:416–423PubMedCrossRefGoogle Scholar
  11. 11.
    Edwards FH, Clark RE, Schwartz M (1994) Coronary artery bypass grafting: The Society of Thoracic Surgeons National Database experience. Ann Thorac Surg 57:12–19PubMedCrossRefGoogle Scholar
  12. 12.
    Grover FL, Johnson RR, Marshall G, Hammermeister KE (1993) Factors predictive of operative mortality among coronary artery bypass subsets. Ann Thorac Surg 56:1296–1307PubMedCrossRefGoogle Scholar
  13. 13.
    Hausmann H, Warnecke H, Ennker J, Schiessler A, Hempel B, Topp H, Schüler S, Hetzer R (1992) Coronary revascularization in end-stage coronary heart disease in relation to assessment of myocardial vitality. Helv Chir Acta 58:495–501PubMedGoogle Scholar
  14. 14.
    Lansman SL, Cohen M, Galla JD, Machac J, Quintana CS, Ergin MA, Griepp RB (1993) Coronary bypass with ejection fraction of 0.20 or less using centigrade cardioplegia: long-term follow-up. Ann Thorac Surg 56:480–485PubMedCrossRefGoogle Scholar
  15. 15.
    Lazar HL, Haan CK (1987) Determinants of myocardial infarction following emergency coronary artery bypass for failed percutaneous coronary angioplasty. Ann Thorac Surg 44:646–650PubMedCrossRefGoogle Scholar
  16. 16.
    Lytle BW, Loop FD, Cosgrove DM, Taylor PC, Goormastic M, Peper W, Gill CC, Golding LA, Stewart RW (1987) Fifteen hundred coronary reoperations. Results and determinants of early and late survival. J Thorac Cardiovasc Surg 93:847–859PubMedGoogle Scholar
  17. 17.
    Milano CA, White WD, Smith LR, Jones RH, Lowe JE, Smith PK, Van Trigt P (1993) Coronary artery bypass in patients with severely depressed ventricular function. Ann Thorac Surg 56:487–493PubMedCrossRefGoogle Scholar
  18. 18.
    Naunheim KS, Fiore AC, Fagan DC, McBride LR, Barner HB, Pennington DG, Willman VL, Kern MJ, Deligonul U, Vandormael MC et al (1989) Emergency coronary artery bypass grafting for failed angioplasty: risk factors and outcome. Ann Thorac Surg 47:816–822PubMedCrossRefGoogle Scholar
  19. 19.
    Paolini G, Zuccari M, Mariani MA, Di Credico G, Pocar M, Galli L, Grossi A (1994) Myocardial revascularization in patients with severe ischaemic left ventricular dysfunction: a clinical experience. Cardiovasc Surg 2:88–92PubMedGoogle Scholar
  20. 20.
    Parsonnet V, Fisch D, Gielchinsky I, Hochberg M, Hussain SM, Karanam R, Rothfeld L, Klapp L (1988) Emergency operation after failed angioplasty. J Thorac Cardiovasc Surg 96:198–203PubMedGoogle Scholar
  21. 21.
    Paz MA, Lupon J, Bosch X, Pomar JL, Sanz G (1993) Predictors of early saphenous vein aortoco- ronary bypass graft occlusion. Ann Thorac Surg 56:1101–1106PubMedCrossRefGoogle Scholar
  22. 22.
    Rahimtoola SH, Fessler CL, Grunkemeier GL, Starr A (1993) Survival 15 to 20 years after coronary bypass surgery for angina. J Am Coll Cardiol 21:151–157PubMedCrossRefGoogle Scholar
  23. 23.
    Seki T, Kitamura S, Kawachi K, Morita R, Kawata T, Mizuguchi K, Hasegawa J, Kameda Y, Yoshida Y (1992) A quantitative study of postoperative luminal narrowing of the internal thoracic artery graft in coronary artery bypass surgery. J Thorac Cardiovasc Surg 104:1532–1538PubMedGoogle Scholar
  24. 24.
    Ulicny KS, Flege JB, Callard GM, Todd JC (1992) Twenty-year follow-up of saphenous vein aortocoronary artery bypass grafting. Ann Thorac Surg 53:258–262PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • B. Schorn
    • 1
  • Ch. Schucht
    • 1
  • H. Dalichau
    • 1
  1. 1.Klinik und Poliklinik für Thorax-, Herz- und GefäßchirurgieGeorg-August-UniversitätGöttingenDeutschland

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