The Practice of Coronary Artery Bypass Surgery, Softcover reprint of the original 1st ed. 1977 Topics in Cardiovascular Disease Series

Few advances in cardiovascular medicine have so captured the inter­ est of physicians and the public alike as has coronary artery bypass surgery. Cardiologists who lived through the era of false hopes and frustrations of previous" operations" for coronary artery disease can fully appreciate what this major advance offers to their patients. The number of papers on this topic presented at national meetings attest to its popularity, but also make it increasingly difficult for anyone to assimilate all the data. Practitioners who must consider coronary artery bypass surgery for their patients may thus have difficulty in coming to some rational decision regarding the indications for the operation and its consequences. Depending on the "authority" that one reads, there is still some controversy as to which patients are candidates for coronary artery surgery. This monograph on the prac­ tice of coronary artery bypass surgery, therefore, comes as a welcome boon to cardiologists, surgeons, internists, and general practitioners who must consider referring their patients for such surgery. It presents a balanced and reasonable picture of the overall subject, in addition to containing important information on such topics as opera­ tive technique and economic impact. Dr. Miller has done an outstand­ ing job in bringing together in one text the important considerations related to the evaluation of patients, the natural history of coronary artery disease and the benefits and problems associated with bypass surgery.

1 A Short History of Myocardial Revascularization.- Previous Operations for Angina Pectoris.- Medical Advances Necessary for Performance of Bypass Surgery.- Coronary Anatomy and Pathology.- Selective Cine Coronary Arteriography.- Extracorporeal Circulation.- Concept of Venous Bypass Grafts.- Development of Techniques for Small-Vessel Anastomoses.- The Growth of Coronary Artery Bypass Surgery.- Aortocoronary Bypass Grafts.- Internal Mammary Artery Bypass Grafts.- Bypass Surgery Today.- References.- 2 The Clinical Course of Patients with Coronary Artery Disease.- The Initial Coronary Event.- Factors Affecting the Prognosis of Patients with Stable Angina Pectoris.- Male Sex.- Noninvasive Studies: Hypertension and an Abnormal Electrocardiogram.- Arteriographic Studies.- The Prognosis of Patients with Unstable Angina.- Myocardial Infarction and Its Association with Angina Pectoris.- The Epidemiology of Sudden Death.- References.- 3 The Benefits of Coronary Artery Bypass Surgery.- Mechanisms of Pain Relief.- Placebo Effect.- Perioperative Infarction.- Interruption of Perivascular Nerves.- Increased Myocardial Blood Flow.- Improved Resting Ventricular Function.- Cardiac Output on Exercise.- Improved Long-Term Survival.- References.- 4 The Risks of Coronary Artery Bypass Surgery.- Preoperative Factors Associated with Increased Operative Risk.- Left Main Coronary Stenosis.- Impaired Resting Ventricular Function.- Impending Myocardial Infarction.- Acute and Recent Myocardial Infarction.- Advanced Age.- Operative Complications Leading to Death or Permanent Disability.- Perioperative Infarction.- Postoperative Bleeding.- Neurologic Complications.- Clamping Injury of the Ascending Aorta with Aortic Dissection.- Wound Sepsis.- Miscellaneous Complications.- Delayed Complications.- Graft Occlusion.- Effects of Bypass Grafts on the Underlying Coronary Circulation.- References.- 5 The Preoperative Evaluation.- Clinical History.- Coronary Arteriography.- Technical Aspects.- Accuracy of the Technique in Identifying Coronary Disease.- Interobserver Variability in Interpretation of Arteriographic Findings.- Pitfalls in Interpretation of Coronary Arteriograms ..- Clinical Correlations.- Risk of Coronary Arteriography.- Ventriculography.- Exercise Testing.- Exercise Duration.- Heart Rate Response.- Blood Pressure Response.- Electrocardiographic Changes.- Risks of Exercise Testing.- References.- 6 Practice Patterns and Factors Influencing Selection of Patients for Bypass Surgery.- Practice Patterns.- Factors Influencing Selection of Patients for Bypass Surgery.- Anatomic Considerations.- Findings on Ventriculography.- Acute Myocardial Infarction.- Type and Severity of Anginal Chest Pain.- Exercise Performance.- Other Factors.- References.- 7 The Use of Extracorporeal Circulation in Bypass Surgery.- Equipment.- Cannulation Techniques.- Basic Concepts of Cardiopulmonary Bypass.- Systemic Heparinization.- Tissue Oxygenation.- Left Ventricular Distention.- The Problem of Systemic Air Embolism.- University of Washington Protocol for Extracorporeal Circulation.- References.- 8 Diagnostic Assessment of Myocardial Injury after Bypass Surgery.- The Pathophysiology of Myocardial Cell Necrosis.- Methods for Assessing Myocardial Injury.- Clinical Findings.- Findings on Ventriculography.- Electrocardiographic Changes.- Diagnosis of Perioperative Infarction by Serum Enzyme Analysis.- CK Isoenzyme Analysis.- Radioisotope Techniques.- References.- 9 Myocardial Protection during Bypass Surgery.- Prevention of Myocardial Damage during Ischemic Arrest.- Ventricular Fibrillation for Distal Anastomoses.- References.- 10 The Role of the Internal Mammary Artery and Other Conduits in Coronary Artery Surgery.- Clinical Experience with Internal Mammary Artery Grafts.- Surgical Anatomy of the Internal Mammary Artery.- Flow Capacity of Internal Mammary Artery Conduits.- Clinical Results with Internal Mammary Artery Bypass Grafts.- Comparison of Patency Rates between Internal Mammary Artery and Saphenous Vein Grafts.- Other Conduits.- Free Internal Mammary Aortocoronary Bypass Grafts.- Splenic Artery and Radial Artery Aortocoronary Bypass Grafts.- Synthetic Bypass Conduits.- Upper-Extremity Veins.- Saphenous Vein Homografts.- References.- 11 Saphenous Vein Aortocoronary Bypass Grafts: Surgical Techniques.- Selection of Saphenous Vein Autografts.- Types of Vein Grafts.- Vein Excision.- Coronary Artery Exposure.- The Proximal Anastomosis.- The Distal Anastomosis.- Complex Grafts.- The Role of Endarterectomy in Vein Bypass Surgery.- References.- 12 The Economics of Bypass Surgery.- Costs of Bypass Surgery.- Cost-Effectiveness of Bypass Surgery.- Allocation of Health Care Resources.- References.