Aortocoronary vein bypass in patients with angina pectoris.

In the 3-year period from May 1971 to April 1974, 90 patients had aortocoronary bypass for angina pectoris at Ulleval Hospital. One patient died shortly after the operation (operative mortality 1.1%). There were no further deaths in the observation period. Clinical improvement was seen in 93% of the patients, early shunt patency in 92%. The study suggests that patients with isolated affection of the right coronary artery should not have bypass, because these patients 1) had less severe symptoms, 2) had better preserved left ventricular function, and 3) seemed to have a smaller chance of benefiting from the operation than the other patients. Multiple shunts gave good clinical results and carried no higher surgical risk than did single shunts. Good clinical results were seen also in patients with occluded shunts provided they had at least one patent shunt too. Graft occlusion occurred early and was associated with low graft flow as measured intraoperatively. Graft occlusion was not usually followed by demonstrable myocardial necrosis. In view of the small operative risk and the high score of symptom relief it is concluded that all patients with angina pectoris that does not readily respond to medical treatment, should be considered for aortocoronary bypass.