Coronary artery surgery as we know it today, has undergone rapid evolution since its introduction in the late 1960's, resulting, not surprisingly, in much confusion. In an attempt to present the state of the art, a collective review of the literature, coupled with the experiences with 118 patients is presented and discussed. The modern surgical management of patients with obliterative coronary artery disease is designed to relieve symptoms, prolong life and identify patients at high risk of premature death or myocardial infarction if they were to continue with medical management. Though the most common indication for surgery is persistent limitation of life style by severe symptoms, management is influenced by the strong association between such symptoms and increased mortality. During the short history of coronary bypass surgery, other indications for operation have been influenced by a combination of lessons from the past and hopes for the future. In addition, advances in technology have produced an enormous impetus for improvements in patient evaluation, surgical technique and postoperative care. As these advances continue and as more and more late results of surgery become available, answers to questions about surgery may increasingly be deduced from lessons rather than from hopes. As a result of these changes, an aura of confusion has gradually crept into the scene. It is hoped that this collective review, together with experiences gained from a personal series of 118 patients over a 3 year period from 1984 to 1986, will put into proper perspective, the state of the art of surgical management of coronary artery disease today.
A personal series of 163 patients who underwent coronary artery bypass surgery (CABG) in the University Hospital, Kuala Lumpur between March 1988 and December 1990 were reviewed retrospectively to determine factors affecting hospital morbidity and mortality. One hundred and thirty eight were elective cases while 25 patients underwent emergency CABG surgery. Of these, 15 patients had recent myocardial infarction, with unstable haemodynamics or post infarct angina; six had failed angioplasty procedures and four patients immediately following coronary angiogram. The elective hospital mortality rate was 2.2% (three cases) and there were two deaths in the emergency group. Pre-operatively 20 patients (13%) had very poor left ventricular function of less than 30% ejection fraction. Significant improvement in ejection fraction was observed following surgery. The follow-up periods were between three months to three years. Ninety eight percent of patients showed improvement in their functional status (NYHA classification) in relation to angina and exercise performance.
The Cardiothoracic Department, General Hospital, Kuala Lumpur which was set up in April 1982, deals with a wide range of cardiac disease, general thoracic and also vascular cases. A total of 2,450 operations were performed from April 1982 to February 1987, and 79.3% of these were for cardiac cases (open and closed heart). This paper reports a review of the 1,110 consecutive open heart operations performed by the Department during the stated period.