Conley M J, Wechsler A S, Anderson R W, Oldham H N, Sabiston D C, Rosati R A
Circulation. 1977 Jan;55(1):158-63. doi: 10.1161/01.cir.55.1.158.
Operative mortality for the first 787 patients who underwent aortocoronary bypass at Duke University Medical Center was 9.7%. Within 699 patients who underwent elective bypass only, operative mortality was 8.8% before January 1, 1972, and 5.4% subsequently. This apparent variation in operative mortality over time was largely a consequence of changing patterns of patient selection, i.e., a two- to three-fold decrease in the prevalence of ventricular dysfunction. Since January 1, 1972, operative mortality for 444 patients with mild or no heart failure who underwent elective bypass only was 5.0%. The 55 patients with left main disease had 12.7% operative mortality. In the 192 patients without left main disease who had one- or two-vessel disease, operative mortality was 1.0%, whereas, 197 patients with three-vessel disease had a 6.6% operative mortality. The 103 patients with three-vessel disease less than 50 years of age underwent operation with a 2.9% mortality. Although these results demonstrate that selected patients may undergo operation with a mortality approaching 1%, it is not clear that only such low risk patients should be offered surgery. Accurate estimates of benefits and risks of aortocoronary bypass surgery are necessary in the management of specific patients.
在杜克大学医学中心接受主动脉冠状动脉搭桥手术的首批787例患者的手术死亡率为9.7%。在仅接受择期搭桥手术的699例患者中，1972年1月1日前的手术死亡率为8.8%，之后为5.4%。这种手术死亡率随时间的明显变化主要是患者选择模式改变的结果，即心室功能障碍患病率下降了两到三倍。自1972年1月1日以来，仅接受择期搭桥手术的444例轻度心力衰竭或无心衰患者的手术死亡率为5.0%。55例患有左主干病变的患者手术死亡率为12.7%。在192例无左主干病变但有单支或双支血管病变的患者中，手术死亡率为1.0%，而197例有三支血管病变的患者手术死亡率为6.6%。103例年龄小于50岁且有三支血管病变的患者手术死亡率为2.9%。尽管这些结果表明部分患者手术死亡率可能接近1%，但尚不清楚是否仅应向这类低风险患者提供手术。在特定患者的管理中，准确估计主动脉冠状动脉搭桥手术的益处和风险是必要的。
