Improved survival beyond 5 years after coronary bypass surgery in patients with left main coronary artery disease.

Abstract To determine the truly late survival of surgically treated patients with left main coronary arterial stenosis, the fafe of 134 consecutive patients with greater than 50 percent stenosis of the luminal diameter of the main left coronary artery who underwent coronary bypass surgery between 1968 and 1973 was determined. Eighty-seven percent (117 or 134) of the patients were men; the mean age was 57 years (range 37 to 70). In addition to left main stenosis, coexistent significant coronary disease was present in other vessels in 128 patients (95.5 percent), with multivessel disease present 109 (81 percent). Ventricular function was good (end diastolic pressure less than 15 mm Hg and no localized contraction abnormality) in 88 patients (66 percent) and poor in 46 patients (34 percent). The perioperative mortality rate was 13 percent (17 patients) in the total group and 11 percent (10 of 88) among patients with good left ventricular function. Postoperative graft patency in 33 patients was 85 percent (58 of 68). All patients were followed up at least 5 years after operation. The survival rate was 79 percent (106 of 134) for the total group, 81 percent (71 of 88) in patients with good ventricular function and 76 percent (35 of 46) in patients with poor ventricular function. Late annual attrition rates were 1.5 percent and 2.1 percent for patients with good and poor ventricular function, respectively. Comparison of these results with the normal U. S. population of identical age and sex distribution indicates that late attrition (excluding perioperative mortality) is almost normal after operation for patients with good ventricular function. Since this early experience between 1968 and 1973, results have improved markedly. These results indicate that excellent long-term survival can be obtained from operation in these patients with severe disease.