Quality of life after coronary bypass surgery

Abstract

This session provided a comprehensive review of coronary bypass surgery upon survival, the relief of symptoms, and upon other less tangible manifestations of the quality of life. Coronary bypass surgery (CABG) is now in its third decade, and the mass of information emanating from the large multicenter, randomized trials, numerous registry studies, and individual series have taught us a great deal about the indications for the procedure and its impact upon late outcome and, in particular, late survival. Much has been made of the differences between the three large randomized trials which compared coronary bypass surgery with medical therapy [the Veterans Administration Trial, the European Coronary Artery Surgery Study (ECSS), and the National Heart, Lung, and Blood Institute Coronary Artery Surgery Study (CASS)] and the patient populations which were entered into these trials do differ in regard to the severity of symptoms, the distribution of the coronary anatomy (particularly in relationship to the frequency of left anterior descending coronary artery disease), and left ventricular function. Less emphasized but of equal, if not greater, importance, however, is the consistent message delivered in each of the three trials; namely, that the greatest benefit of coronary revascularization upon survival is achieved among subsets of patients at higher risk. The latter can be categorized on the basis of the severity of ischemia, the presence of left ventricular dysfunction, and the number of vessels diseased and their location.