Curcio C A, Barnard M S, Berloco P, Barnard C N
G Ital Cardiol. 1981;11(3):297-302.
The surgical treatment of coronary artery disease still remains controversial, despite the fact that the surgical indications are widely recognized and so the efficacy of the aortocoronary bypass in relieving angina and in improving the prognosis of the patients with left mainstem lesions. However, one gets the impression that the criteria for surgery not always are correctly applied, with the consequence that the bypass is often performed on patients that could still benefit from proper medical treatment. At Groote Schuur Hospital, during the period 1976-78, we have bypassed a total of 395 coronary arteries in 204 patients. All the patients were in NYHA class III and IV. The peculiarity of this rather small series is based on the conservatism of the selection criteria, the operation being offered only to candidates with a very long history of angina uncontrolled by adequate medical treatment. The early mortality rate has been 1.47%, the late mortality rate 3.5% and the perioperative infarction rate 10.8%. All the patients have been followed up for 12-48 months (mean follow up 30.3 months). 80% of the patients returned in class I and 13.5% in class II. 80 out of 112 patients operated during 1976-77 have had routine coronary angiography one year post-surgery: the graft patency rate in this group has been 71%. The majority of the obstructed grafts were related to small vessels of 1 mm in diameter. On the basis of these clinical results we conclude that no controversy is justified once and adequate trial with proper medical treatment has already failed.
尽管冠状动脉疾病的手术指征已得到广泛认可，主动脉冠状动脉搭桥术在缓解心绞痛以及改善左主干病变患者预后方面的疗效也已得到公认，但冠心病的外科治疗仍存在争议。然而，人们感觉手术标准并非总是得到正确应用，结果往往是对那些仍可从适当药物治疗中获益的患者进行了搭桥手术。在格罗特·舒尔医院，1976年至1978年期间，我们共为204例患者的395支冠状动脉进行了搭桥手术。所有患者均为纽约心脏协会（NYHA）分级III级和IV级。这个规模相对较小的系列病例的特点在于选择标准较为保守，仅为那些有很长时间心绞痛病史且经充分药物治疗仍无法控制的患者提供手术。早期死亡率为1.47%，晚期死亡率为3.5%，围手术期梗死率为10.8%。所有患者均接受了12至48个月的随访（平均随访30.3个月）。80%的患者恢复到I级，13.5%恢复到II级。1976年至1977年接受手术的112例患者中有80例在术后一年进行了常规冠状动脉造影：该组移植血管通畅率为71%。大多数阻塞的移植血管与直径1毫米的小血管有关。基于这些临床结果，我们得出结论，一旦充分的药物治疗试验失败，就没有理由再存在争议。
