Current status and problems in long-term management of patients undergoing coronary artery bypass surgey in Japan.

Abstract

We studied 272 patients undergoing coronary artery bypass surgery (CABS) to clarify the long-term effects of CABS and to identify problems in long term management. Data on patients' pre and postoperative medical status were obtained from hospital files. A specially designed questionnaire was sent to all patients to assess residual angina, return to work, non-work physical activity and improvement in the quality of life after a mean follow-up of 29 months. Multivessel disease accounted for 89% of all patients and complete revascularization was achieved in 55%. A total of 131 events of complications associated with CABS occurred in 112 patients ; post-transfusion hepatitis was the most frequent complication (26%). Graft patency rate was 89% at the time of hospital discharge. Bypass grafts were patent in 95% of 243 grafts which were restudied at a mean period of 19 months after the first study. There was no significant difference in the patency rate between patients with well controlled, poorly controlled or discontinued anticoagulant therapy. Patients who were relieved from angina, returned to gainful work and had no limitation in non-work physical activity accounted for 74%, 79% and 73%, respectively. By subjective assessment, the quality of life improved in 76% of all patients. Objectively, contributing factors preventing improvement in the life quality were residual angina and post-transfusion hepatitis. There were 13 patients who were readmitted because of cardiac events. Three patients died from these events including two from sudden death during follow-up. We conclude that the beneficial effects of CABS are actually attainable. New approaches shoud be considered for increasing graft patency rate to an angina-producing artery and in preventing post-transfusion hepatitis. In this study, the benefits of the long-term use of anticoagulant therapy is questionable.