The first decade of aortocoronary bypass grafting, 1967-1977. A review.

Abstract

Despite a decade of experience with aortocoronary bypass grafting embracing 300,000 or more operations, indications for its use remain controversial. The controversy persists because of a lack of adequate controls with which to compare the clinical course of operated patients; only 1248 were reported who were studied in a carefully controlled and random manner. Benefit was claimed frequently by comparing the course of patients treated surgically with medically treated patients followed the decade before. Such comparisons are not valid in view of the well documented changes in the natural history of coronary artery disease that were occurring during the last decade. Despite a low operative mortality and rate of graft closure, available data in the literature do not indicate that initial symptomatic improvement necessarily persists or that myocardial infarctions, arrhythimas, or congestive heart failure will be prevented or that life will be prolonged in the vast majority of operated patients.