Results of ten years aorto-coronary bypass surgery at the Thoraxcenter, Rotterdam

The aim of this thesis is the description of the outcome of isolated aortacoronary bypass operations, both regarding the short term effects i.e. the operative mortality as well as the Long term results i.e. the general wellbeing and survival probability of the patients over the years. The main indication for this type of surgery is and always has been, persisting angina pectoris despite extensive pharmacological therapy. The outcome of surgery therefore, should be judged, among other things, by the presence and severity of this syndrome in the post-operative period. To place these data in perspective, a review of the Literature on surgical therapy of angina is provided in chapter 2. As discussed in chapter 3, it has become apparent over the years that the perception of the severity of angina pectoris is changeable and very difficult to quantify. Still an attempt has been made, to analyse the data on this complaint, although it is realised that it is fraught with errors as simplifications are required when Large numbers are to be judged. Improved survival has by now become an important issue to justify bypass surgery. A multivariate analysis of the factors which influence survival is provided in chapter 4. For comparison, the survival probability of the general population in the Netherlands, matched for age and sex, has been related to the data of the patients under study. In chapter 5 the evolution in post-operative chest pain is documented, while the results of re-operations of patients who underwent their primary operation at the Thoraxcenter, are discussed in chapter 6. In chapter 7 a correlation is sought between the presence of pain in the chest and the extent of vascular involvement in the pre- and postoperative angiograms. Patency of the grafts and progression of disease in relation to post-operative pain is discussed as well in these chapters. Chapter 8 contains a general but critical discussion of bypass surgery in an attempt to view, from all angles, the relative merits and disadvantages of this currently so popular procedure. This study would not have been possible without the generous help of our patients. First by their part in the design of the questionnaire and Later by their responding to it in such Large numbers. To emphasize that this material ultimately relates to the specific problem of the individual patient, the histories of 4 patients are represented in a detailed but compressed form. Their stories reflect, better perhaps than statistics, what it means to have a "BYPASS OPERATION"