Interventions for coronary stenosis--a Canadian experience of 30 revolutionary years.
OBJECTIVE
To report 2324 coronary stenosis interventions (Vineberg procedures [VbP], coronary artery bypass graft operations [CABG] and percutaneous transluminal coronary angioplasties [PTCA]), in 1711 patients of a Canadian military hospital between 1965 and 1995 and to report their evolution and interaction in a historical context.


METHODS
Retrospective examination of clinical and angiographic findings in hard records, collected from the beginning for long term follow-up and later embedded in a custom-designed computer database.


METHODS
Most were male, mean ages 43.2 and 43.3 years for first and second VbPs; 48.9 and 58.2 years for first and repeat CABGs; and 53.4 and 59.9 years for first and repeat PTCAs, respectively; 12% of all patients were 39 years old or younger at the first intervention.


METHODS
There were 160 VbPs, 1637 CABGs and 527 PTCAs. Of 1711 subjects, 74% had only one procedure, 15% had more than one of the same kind, and 11% had more than one of different kinds.


RESULTS
Perioperative mortality for VbPs was 4.4%; for 'isolated' first CABGs it was 1.4% and 6.6% for reoperations, when other concurrent major cardiac procedures, excepting ventricular aneurysm repair, were excluded. It was 0.4% for PTCAs. Perioperative mortality for all 1761 'isolated' coronary interventions necessitating thoracotomy, during 30 years, was 2.4%. Angiographic follow-up rates were high and some findings are reported, including early postoperative patency rates for 5065 coronary bypass grafts, and long term follow-up data on graft patency and disease.


CONCLUSIONS
Each intervention was used to circumvent or relieve coronary stenosis, in the early years when it became available and, later, as was most appropriate for dealing with specific clinical problems. The impact of advances in the evolution of these interventions on therapeutic decision-making is discussed. Finally, tributes are paid to those responsible for making these procedures possible, including a Canadian surgeon whose role was pivotal.
FitzGibbon
G M
GM
Cardio-Pulmonary Unit, National Defence Medical Centre, Ottawa, Ontario.
Kafka
H P
HP
Leach
A J
AJ
Burton
J R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002170:Canada; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D012086:Reoperation; D012189:Retrospective Studies; D014654:Vascular Patency