Coronary artery bypass grafting : the state of the art

Abstract

There is now considerable evidence that surgery for cononary artery disease relieves angina very effectively and indeed is more effective in the treatment of angina than medical treatment in matched and randomised series. Furthermore,: coronary artery bypass surgery· improves life expectancy in those patients who have significant disease of the left main stem or of all three major vessels three vessel disease. Some data behind these statements will be mentioned in this article. It is first important to appreciate the anatomy we are discussing. The left main stem is a small part of the origin oUhe left coronary artery and clearly disease here is liable to put the whole of the left ventricle at risk. The right coronary artery, the left anterior· descending and the left circumflex are the three major vessels. The term three vessel disease implies disease of each of these vessels. Clearly' there are sub- branches of these vessels, and these in turn may be diseased. There is some variation between patients in the relative distribution of their coronary arteries and in the number and size of their sub-branches. This variation plays some part in the assessment of the patient for operations and in the technicalities of where and how many grafts are placed. However, it has not been used in the analysis of the re'sults of the trials for angina or survival.