Since Favaloro introduced coronary artery bypass grafting in 1969,1 results have improved steadily even though the procedure has been applied to more patients that are older, with more extensive disease, and worse left ventricular function.2 In spite of recent success of percutaneous angioplasty for multi-vessel disease and relatively normal left ventricles, bypass surgery has been preferred for those with three-vessel disease and severe left ventricular dysfunction.3–6 Evidence for the role of surgical revascularization in patients with symptomatic diffuse coronary artery disease and impaired left ventricles was first noted in the 1984 report of the Veterans Administration Cooperative Trial7 that demonstrated an 11-year survival advantage over medical therapy of 12% (50% vs. 38%). The definition of abnormal left ventricle was generous by today’s surgical standards and included ejection fraction of 40% or below and included only patients with stable angina.This study was reinforced by the CASS report in 1985,8 and The Veterans Administration Medical Center’s results were similar when extended to patients with an unstable pattern of angina.9
KeywordsObesity Ischemia Stratification Luminal Cardiomyopathy
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