What are the clinical outcomes, mortality, and morbidity rates associated with saphenous vein bypass surgery?
Early data on saphenous vein bypass surgery demonstrates high rates of angina relief but notable operative mortality and morbidity, prompting the development of preoperative risk-benefit guidelines.
The results of the first 400 consecutive patients (335 males, 65 females; mean age 52 years) having saphenous vein-coronary artery graft surgery at Stanford between October 1968 and January 1972 were reviewed. Through patient or physician contact, 100% follow-up period was achieved in the 375 patients surviving surgery. The mean follow-up period was 9.9 months, with the range 2 to 40 months. The operative mortality was 6.5%; patients having this surgery electively had a 0.8% mortality. The major cause of operative mortality was myocardial infarction (9 patients) and congestive heart failure and cardiogenic shock (10 patients). Predominant postoperative morbidity was due to pulmonary emboli (17 patients) and intrathoracic hemorrhage requiring thoracotomy (11 patients). The use of anticoagulants in the early postoperative period has reduced the incidence of pulmonary emboli. Angina was completely relieved in 79% (295 patients), 237 of whom had returned to full time employment. However, another 12% either were unchanged from their preoperative symptomatic state or incurred major late complications. This group includes 15 patients (3.9%) who had late deaths from cardiovascular causes. Another 23 patients had late, nonfatal myocardial infarctions. Using as a data base the degree of preoperative congestive heart failure, the extent of electrocardiographic changes and the presence of mitral regurgitation, a prognostic preoperative clinical risk-benefit guideline has been developed for use in any patient undergoing saphenous vein coronary artery graft surgery.
Cannom et al. (1974) studied this question.