[Surgical myocardial revascularization: indications, perioperative risk constellation and prognosis].
Since the inception of coronary artery bypass grafting, refinements in surgical technique, myocardial preservation, anesthesia and in pre- and postoperative care, reduced the perioperative mortality and improved the long-term results in patients with chronic coronary artery disease. Large-scale, multicentre randomized and a multitude of non-randomized clinical trials of surgical versus medical treatment have set therapeutic standards for quality and refined the indications for bypass surgery. In summary, these studies clearly indicate that surgery is superior to medical therapy in symptom relief, decreased antianginal drug use and improved exercise performance, but does not improve the likelihood of return to employment, non-fatal myocardial infarction prevalence or hospitalization rates. After surgery, survival is prolonged in those subsets of patients who are considered at high risk, i.e. patients with left main disease (greater than 70%), with two-vessel disease with severe left anterior descending artery stenosis or with three-vessel disease with signs of significant ischemia on exercise or left ventricular dysfunction present. Specific individual risk profiles during coronary artery surgery were evaluated by a multicentre retrospective analysis of 8363 patients (QuaDRA-study) documenting a significantly higher perioperative letality and incidence of postoperative complications (low output syndrome, infection, renal dysfunction, psychosyndrome) in the elderly (greater than 65 years).
Korb
H
H
Klinik und Poliklinik für Herzchirurgie, Universität Köln.
Borowski
A
A
Christof
K
K
Deimel
U
U
de Vivie
E R
ER
D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D009204:Myocardial Revascularization / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate
Die chirurgische Myokardrevaskularisation: Indikation, perioperative Risikokonstellation und Prognose.