Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1989 Sep;44(9):721–724. doi: 10.1136/thx.44.9.721

Coronary artery bypass surgery: current practice in the United Kingdom.

G D Angelini 1, A J Bryan 1, R R West 1, A C Newby 1, I M Breckenridge 1
PMCID: PMC462052  PMID: 2588208

Abstract

A survey of current clinical practice was carried out among the 84 consultant cardiac surgeons currently performing coronary artery bypass surgery in the United Kingdom. The 80 surgeons who returned the questionnaire performed an estimated total of 17,100 coronary artery bypass graft operations in 1987, a mean case load of 214 operations each. Sixty two of the 80 surgeons regarded the internal mammary artery as the graft conduit of choice, and seven preferred the saphenous vein. The internal mammary artery was used in 73% of bypass grafts to the left anterior descending coronary artery but in only 4% of grafts to the circumflex and right coronary systems. Contraindications to the use of the internal mammary artery included advanced age of the patient (51 surgeons), insufficient flow through the internal mammary artery (49), and endarterectomy (35). Seventy four of the 80 surgeons considered intraoperative damage to the saphenous vein to be a possible cause of vein graft failure, but there was no agreement about how it should be reduced. All surgeons advocated pharmacological measures to enhance graft patency. Dipyridamole and aspirin constituted the most popular regimen (58 surgeons), though only 28 started dipyridamole preoperatively. Warfarin was prescribed postoperatively on occasion by 22 surgeons, but 14 of these used it only after endarterectomy.

Full text

PDF
721

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Angelini G. D., Breckenridge I. M., Butchart E. G., Armistead S. H., Middleton K. M., Henderson A. H., Newby A. C. Metabolic damage to human saphenous vein during preparation for coronary artery bypass grafting. Cardiovasc Res. 1985 Jun;19(6):326–334. doi: 10.1093/cvr/19.6.326. [DOI] [PubMed] [Google Scholar]
  2. Angelini G. D., Breckenridge I. M., Psaila J. V., Williams H. M., Henderson A. H., Newby A. C. Preparation of human saphenous vein for coronary artery bypass grafting impairs its capacity to produce prostacyclin. Cardiovasc Res. 1987 Jan;21(1):28–33. doi: 10.1093/cvr/21.1.28. [DOI] [PubMed] [Google Scholar]
  3. Bonchek L. I. Prevention of endothelial damage during preparation of saphenous veins for bypass grafting. J Thorac Cardiovasc Surg. 1980 Jun;79(6):911–915. [PubMed] [Google Scholar]
  4. Braunwald E. Effects of coronary-artery bypass grafting on survival. Implications of the randomized coronary-artery surgery study. N Engl J Med. 1983 Nov 10;309(19):1181–1184. doi: 10.1056/NEJM198311103091911. [DOI] [PubMed] [Google Scholar]
  5. Campeau L., Enjalbert M., Lespérance J., Bourassa M. G. Course of angina 1 to 12 years after aortocoronary bypass surgery related to changes in grafts and native coronary arteries. Can J Surg. 1985 Nov;28(6):496–498. [PubMed] [Google Scholar]
  6. Chesebro J. H., Clements I. P., Fuster V., Elveback L. R., Smith H. C., Bardsley W. T., Frye R. L., Holmes D. R., Jr, Vlietstra R. E., Pluth J. R. A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency. N Engl J Med. 1982 Jul 8;307(2):73–78. doi: 10.1056/NEJM198207083070201. [DOI] [PubMed] [Google Scholar]
  7. Fuster V., Dewanjee M. K., Kaye M. P., Josa M., Metke M. P., Chesebro J. H. Noninvasive radioisotopic technique for detection of platelet deposition in coronary artery bypass grafts in dogs and its reduction with platelet inhibitors. Circulation. 1979 Dec;60(7):1508–1512. doi: 10.1161/01.cir.60.7.1508. [DOI] [PubMed] [Google Scholar]
  8. Gershlick A. H., Syndercombe Court Y. D., Murday A. J., Lewis T., Mills P. G. Platelet function is altered by autogenous vein grafts in the early postoperative months. Cardiovasc Res. 1984 Feb;18(2):119–125. doi: 10.1093/cvr/18.2.119. [DOI] [PubMed] [Google Scholar]
  9. Grondin C. M. Graft disease in patients with coronary bypass grafting. Why does it start? Where do we stop? J Thorac Cardiovasc Surg. 1986 Sep;92(3 Pt 1):323–329. [PubMed] [Google Scholar]
  10. Grondin C. M. Late results of coronary artery grafting: is there a flag on the field? J Thorac Cardiovasc Surg. 1984 Feb;87(2):161–166. [PubMed] [Google Scholar]
  11. Gundry S. R., Jones M., Ishihara T., Ferrans V. J. Optimal preparation techniques for human saphenous vein grafts. Surgery. 1980 Dec;88(6):785–794. [PubMed] [Google Scholar]
  12. Hampton J. R. Coronary artery bypass grafting for the reduction of mortality: an analysis of the trials. Br Med J (Clin Res Ed) 1984 Nov 3;289(6453):1166–1170. doi: 10.1136/bmj.289.6453.1166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Julian D. G. The practical implications of the coronary artery surgery trials. Br Heart J. 1985 Oct;54(4):343–350. doi: 10.1136/hrt.54.4.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lefrak E. A. The internal mammary artery bypass graft: praise versus practice. Tex Heart Inst J. 1987 Jun;14(2):139–143. [PMC free article] [PubMed] [Google Scholar]
  15. Loop F. D., Lytle B. W., Cosgrove D. M., Stewart R. W., Goormastic M., Williams G. W., Golding L. A., Gill C. C., Taylor P. C., Sheldon W. C. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986 Jan 2;314(1):1–6. doi: 10.1056/NEJM198601023140101. [DOI] [PubMed] [Google Scholar]
  16. Miller D. W., Hessell E. A., Winterscheid L. C., Merendino K. A., Dillard D. H. Current practice of coronary artery bypass surgery. Results of a national survey. J Thorac Cardiovasc Surg. 1977 Jan;73(1):75–83. [PubMed] [Google Scholar]
  17. Miller D. W., Jr, Ivey T. D., Bailey W. W., Johnson D. D., Hessel E. A. The practice of coronary artery bypass surgery in 1980. J Thorac Cardiovasc Surg. 1981 Mar;81(3):423–427. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES