J.Jpn. Surg. Soc.. 80(11): 1086-1091, 1979

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Report on the annual meeting

SURGICAL INTERVENTION FOR CORONARY ATHEROSCLEROTIC DISEASE

Since 1969, direct coronary surgery has been performed in 54 patients with sever coronary sclerotic disease in this surgical department. They were divided into two groups according to operative procedures applied to angina pectoris and myocardial infarction. To date, 36 cases of A-C bypass and one case of aorto-coronary sinus bypass as a arterialization of the coronary vein were operated on. Four cases died of LOS postoperatively and one case who underwent A-C bypass after Vineberg's operation died of arrhythmia 10 years after the previous procedure. The remaining 32 cases are doing well with no complaints in the angian group during the following up from ranging 2 weeks to 9 years (mean 3 years 6 months). The myocardial infarction group consisted of 17 cases as follows: aneurysmectomy 2, scartectomy 5, myocardial infarctectomy 2, closure of postinfarction VSD 3, MVR for mitral regurgitation 3, and emergency A-C bypass 2.
Besides, intraaortic balloon pumping (IABP) was employed in 16 cases with cardiogenic shock due to acute myocardial infarction and in 3 cases after coronary heart surgery. Subsequently, 6 out of 16 cases with cardiogenic shock and 1 out of 3 cases after surgery could be weaned from IABP. Our surgical procedures are as follows. The coronary artery is incised, and anastomosis between coronary artery and saphenous vein is performed under cardiac arrest due to cardioplegic solution and local cardiac cooling. The vent catheter is not necessary to decompress the left ventricle in these maneuvers. Myocardial resection is done under induced ventricular fibrillation, and the suture line is reinforced with Teflon felt.
Finally, the current status of direct coronary surgery in Japan is discussed. Up to Feb. 15 1979, 1928 cases (A-C bypass for 1487 cases, surgery for myocardial infarction for 441 cases) have been totally operated on. The survival rate for all cases is 79.4%. The single bypass has a remarkably good rate of 89%, and that of aneurysmectomy is 81%. The last result compares favorable with that of the United States.

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