Surgical Treatment for Severe Coronary Heart Disease : Its Indication and Result : Medical and Surgical Aspects of Treatment of "High Risk" Cardiovascular Diseases

There still remain several controversies in the treatment of severe coronary heart disease. We examined 147 patients who underwent surgery during the past 6 years. These patients were classified into the following 4 groups: 1) patients with serious mechanical complications, such as ventricular septal perforation and cardiac rupture, in the acute stage of myocardial infarction (11 patients), 2) unstable angina (45 patients), 3) those with congestive heart failure (15 patients) and 4) stable angina with left main trunk and/or triple-vessel disease (76 patients). Surgical mortality rates in each group were 45.5, 11.1, 6.6 and 3.9%, respectively. It was concluded: 1) In the patients with mechanical complications in acute myocardial infarction emergency surgery should be undertaken even in the acute stage, if cardiogenic shock has deteriorated despite the use of intraaortic balloon pumping. 2) The necessity of urgent surgery of patients with unstable angina who have severe organic lesions is self-evident. In some patients, however, coronary vasospasm played a significant role in its clinical manifestations and surgery at this stage was not satisfactory. Medical treatment should precede the surgery. 3) In patients with early symptoms of congestive heart failure surgery should be performed before heart failure ensues. 4) Results of the surgery for stable angina with left main trunk and/or triple-vessel disease were satisfactory.