Direct Coronary Artery Surgery

The background of surgery leading to bypass for obstructive coronary artery disease is reviewed, and representative case histories are presented. One patient of ten who underwent coronary bypass surgery died; the remaining nine are well. The key to case selection lies in accurate arteriography to determine the state of the coronary vessels, and left ventriculography to establish the functional state of the left ventricle. Intractable angina with remediable obstruction is the main indication for surgery, but Indications are rapidly widening. Aspects of surgical technique are discussed, and the advisability of anastomosing all veins to the aorta is stressed. The age-old difficulty of assessing the result in both objective and subjective terms Is considered. The extent of the problem, and the paucity of investigative laboratories and of technical assistance and trained surgeons are indicated.