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PubMedDate not supplied

Improved functional results following myocardial revascularization in patients with left ventricular dysfunction.

Between February 1978 and October 1982, 40 patients with preoperative ejection fraction (EF) of 0.35 or less underwent aortocoronary bypass. An average of 3.1 saphenous vein grafts per patient were inserted and revascularization was considered complete in 33 (82%) of the subjects in the group. Mean follow-up period was 29 months (range 12-65 months). Early mortality was 5% (2 patients) and there were seven late deaths (3 cardiac and 4 non-cardiac). The five-year cardiac actuarial survival rate was 74% +/- 13% (+/- SEM). Angina has improved in 29 (94%) of the 31 long-term survivors with 23 (74%) being totally asymptomatic. Twenty-two of the long-term survivors performed an exercise test at the end of their follow-up period. These tests revealed that bypass surgery in such patients results in significantly enhanced myocardial oxygen consumption with concomitant increase in effort level and duration. The exercise ability is probably directly related to the degree of revascularization.

Actuarial Analysis↗

PubMed2001

Diaphragmatic shape change after lung volume reduction surgery.

Diaphragmatic shape in normal patients was significantly different from shape in emphysema patients. Postoperative diaphragmatic shape in patients with good clinical outcome differed from preoperative shape and was similar to shape in normal patients. In patients with poor clinical outcome, surgery appeared to have little effect on diaphragm shape.

Diaphragm↗

PubMed1988

Long-term follow-up by exercise radionuclide angiography of patients after valve replacement for aortic regurgitation.

The long-term effects of valve replacement for chronic isolated aortic regurgitation as assessed by first-pass exercise radionuclide angiography have never been reported. We studied 20 males and 5 females before, 15 months postoperatively, and from 29 to 109 (mean 62 +/- 21) months following valve replacement with exercise radionuclide angiography. Mean peak heart rate did not change for the three studies. Peak systolic blood pressure decreased from 201 +/- 42 mmHg to 185 +/- 24 mmHg at 15 months and further declined to 177 +/- 32 mmHg by the long-term study (p less than 0.03). The mean resting left ventricular ejection fraction improved from 44 +/- 15% preoperatively to 57 +/- 18% at 15 months (p less than 0.002) with no further improvement by the long-term evaluation. The postexercise ejection fraction improved from 42 +/- 13% preoperatively to 61 +/- 21% at 15 months (p less than 0.002) also with no change by the long-term study. The duration of exercise improved from 9.7 +/- 4.6 min to 11.9 +/- 3.4 min (p less than 0.03) at 15 months with no additional improvement long term. Improvement in resting and postexercise ejection fraction and in exercise duration is maximal at 15 months. Accuracy and cost containment suggest that assessment of the maximal change in ejection fraction by exercise radionuclide angiography after aortic valve replacement in asymptomatic patients be limited to the 15-month interval.

Adult↗

PubMed1986

Successful repair of double-outlet right ventricle by a modified Fontan operation.

Patients having a double-outlet right ventricle with an unfavorable anatomy for reparative conduit procedure present a formidable surgical challenge. Three such patients, aged 10, 13, and 14 years, with double-outlet right ventricle associated with atrioventricular discordance in 2 and atrioventricular concordance in 1, levotransposition of the great vessels and dextrocardia. A large-diameter direct anastomosis of the right atrium to the pulmonary artery was performed after the closure of the atrioventricular and pulmonary valves. All patients were operated on successfully with good clinical and hemodynamic results. Postoperatively, all 3 were acyanotic and had an improved physical activity compared with their preoperative status. Mean cardiac index at rest was 3.23 L/min/m2 and was increased to 5.04 L/min/m2 during exercise. These results indicate that this procedure can be of value for patients with double-outlet right ventricle in whom reparative surgery is technically difficult or infeasible.

Adolescent↗

PubMed1981

Spontaneous idiopathic hematoma of the spermatic cord: a report of 2 cases.

We present 2 cases of spontaneous idiopathic spermatic cord hematoma and review the literature. These hematomas predominately occur in untraumatized young adults after physically stressful exercise. Surgical exploration was performed in 4 previously reported cases and our own. In each case the preoperative diagnosis was incorrect. Since this clinical entity cannot clearly be distinguished from other causes of an acute scrotum surgical exploration seems warranted. Possible etiologies of spontaneous idiopathic spermatic cord hematoma are spermatic cord vein rupture and tear in the cremasteric muscle.

Adult↗

PubMed1999

Homograft valve insertion for pulmonary regurgitation late after valveless repair of right ventricular outflow tract obstruction.

OBJECTIVE: Pulmonary regurgitation after valveless repair of right ventricular outflow tract obstruction (RVOTO) results in progressive right ventricular (RV) dilatation and dysfunction in an increasing number of patients. Since 1989, we have exclusively used cryopreserved homografts to restore pulmonary valve competence in these patients. Our 9-year-experience with pulmonary valve insertion (PVI) in such cases has been reviewed to evaluate the indications for this procedure and its benefits. METHODS: From 1989 to 1998, 49 patients (original diagnosis: tetralogy of Fallot in 42 patients and pulmonary stenosis in seven) aged from 3 to 42 years (mean 18 +/- 9 years) underwent PVI with homografts late (mean 13 +/- 7 years) after valveless repair of RVOTO (transannular patch, n = 38; pulmonary valvulotomy therefore tau chi infundibular patch, n = 11). Preoperatively, all patients had severe pulmonary regurgitation, cardiomegaly, significant to severe RV dilatation and dysfunction, fatigue, reduced exercise tolerance, and were in NYHA class II (n = 43) or III (n = 6). Ten patients had ventricular arrhythmia. RESULTS: There was one early death, due to air embolism, and one late death, due to ventricular arrhythmia. All survivors but one, who subsequently underwent heart transplant, had symptomatic improvement after homograft insertion. The mean RV end-diastolic diameter decreased from 38 +/- 9 to 26 +/- 8 mm (P < 0.01), and cardiothoracic ratio decreased from 0.62 +/- 0.07 to 0.54 +/- 0.04 (P < 0.01). Good late homograft function was the rule, with all the survivors being free of reoperation for valve failure. At a mean follow-up of 42 +/- 28 months, 41 patients (87% of the survivors) were in New York Heart Association (NYHA) class I and six in class II. Within this group three patients are still in treatment for RV failure and five for ventricular arrhythmias. In these patients, the average interval between RVOTO repair and PVI was significantly longer than in the others (18 +/- 7 vs. 12 +/- 6 years, P < 0.01). CONCLUSION: Homograft PVI is safe and provides clinical improvement with a significant reduction in RV volume overload and excellent mid-term results in most patients with severe PR late after RVOTO repair. This procedure should be undertaken early in symptomatic patients, before severe RV failure and ventricular arrhythmias ensue.

Adolescent↗

PubMed2001

Optimizing preoperative lung function.

The exacerbation of chronic lung disease, bronchospasm, atelectasis, pneumonia, and respiratory failure with prolonged mechanical ventilation are considered to be clinically relevant postoperative pulmonary complications associated with increased morbidity and mortality. Careful history taking and a thorough physical examination are the most sensitive ways to identify patients at risk. Lung function tests serve as management tools for optimizing preoperative therapy and to assess postoperative lung function and individual risk in lung resection candidates. Additional cardiopulmonary exercise testing provides valuable information in borderline cases. The cessation of smoking, optimizing nutritional status and physiotherapy serve to prevent postoperative pulmonary complications. Moreover, medical therapy is recommended, especially for patients with obstructive airway diseases. In the absence of controlled clinical trials, medical therapy along the respective guidelines, with the primary goals of minimizing symptoms and improving lung function to the optimum seems to be a reasonable approach.

Journal Article↗

PubMed1990

Increased mortality of women in coronary artery bypass surgery: evidence for referral bias.

STUDY OBJECTIVE: To determine whether differences in referral reasons explain the higher operative mortality of women in coronary artery bypass surgery. DESIGN: Case series. SETTING: A tertiary care, private teaching hospital. PATIENTS: Consecutive patients who had isolated coronary artery bypass surgery between 1982 and 1987 (total, 2297; 79% male and 21% female). MEASUREMENTS AND MAIN RESULTS: The inhospital mortality rate was significantly higher for women than for men (4.6% compared with 2.6%; P = 0.036; 95% CI for difference in mortality, 0% to 4.0%). Women were older than men (mean, 68.2 and 64.0 years, respectively; P less than 0.001), and a higher percentage of women were referred with unstable angina (P = 0.007), postmyocardial infarction angina (P = 0.029), congestive heart failure (P less than 0.001), and New York Heart Association class IV symptoms (66% compared with 45%, P less than 0.001). More men were referred with a history of an abnormal exercise test (P less than 0.001), and patients referred because of a positive exercise test had a lower mortality (P less than 0.001). Using multivariate analysis, adjustment for the higher preoperative functional class of women and for age accounted for all of the difference in mortality between men and women (odds ratio, 1.04; CI, 0.60 to 1.79; P = 0.89). After correction for functional class alone, there continued to be no significant difference in mortality between men and women (P = 0.40). CONCLUSIONS: Differences in functional class and age account for the higher operative mortality of women in coronary bypass surgery. Women are referred for coronary bypass surgery later in the course of their disease than men, and later referral may increase their changes of operative death.

Adult↗

PubMed2001

Complications of thermal capsulorrhaphy.

As the popularity of thermal capsular shrinkage continues to increase, analysis of complications and failures will continue to provide helpful information in guiding patient selection and decreasing morbidity. Patients who are undergoing revision surgery or who have a history of multiple preoperative dislocations appear to be at higher risk for failure with thermal shrinkage surgery. Caution should be exercised for patients who participate in contact or collision sports, as well as those with MDI. Further study may determine whether thermal shrinkage is most appropriate for microinstability or used as an adjunct to other stabilization procedures.

Electrocoagulation↗

PubMed1986

The use of lumbar extension in the evaluation and treatment of patients with acute herniated nucleus pulposus. A preliminary report.

Many patients with acute herniated nucleus pulposus can be expected to resolve their conditions with conservative management. To date, however, no reliable sign has been described in the literature that can predict which patient will respond. This report shows that the ability to achieve normal lumbar extension represents such a sign. Of 67 patients who met the criteria for inclusion in the study, 35 patients were treated without operation; 97% were able to achieve normal lumbar extension within three days of admission to the hospital. Thirty-two patients underwent laminotomy and discectomy because they failed to improve with conservative measures. Of these patients, only two (6%) were able to achieve normal lumbar extension preoperatively. Furthermore, some of these patients responded so dramatically to extension therapy that the use of extension exercises as a therapeutic modality is recommended.

Adolescent↗

PubMed1985

Surgical management of chronic pulmonary embolism.

Recurrent pulmonary emboli ultimately may produce respiratory insufficiency, severe hypoxemia, and progressive pulmonary hypertension. In many patients this syndrome is silent in its initial phases, and when thrombophlebitis is present it is often unresponsive to anticoagulant therapy. Unless pulmonary embolectomy is undertaken, most of these patients characteristically succumb with severe respiratory insufficiency. Twenty-five patients with this syndrome have been evaluated at the Duke University Medical Center, and 14 were selected for elective pulmonary embolectomy for relief of severe and incapacitating pulmonary insufficiency. In each patient preoperative pulmonary scans and arteriography demonstrated a high degree of vascular occlusion. The obstructing lesions affected both lungs in the majority of patients. Bronchial arteriography was found to be a very valuable method for demonstrating patency of the pulmonary arteries distal to occluding lesions by retrograde filling through collateral vessels joining the bronchial and pulmonary circulations. Preoperatively radionuclide angiocardiography revealed severe right ventricular dysfunction with significantly depressed ejection fractions at rest and during exercise. Retrograde pulmonary arterial flow as shown by selective bronchial arteriography was excellent in ten patients, fair in three, and absent in one. Long term follow-up indicated a clear relationship between the magnitude of arterial backflow at the time of embolectomy and the degree of clinical improvement. There were two perioperative deaths, one from massive reperfusion pulmonary hemorrhage and another from intractable right ventricular failure. Eleven patients with this syndrome were unsuitable candidates for embolectomy and of these, nine had severe distal emboli diffusely spread in the small pulmonary arteries and not amenable to direct removal. One patient had severe right ventricular failure with extreme pulmonary hypertension (145/45 mmHg) and another was massively obese with severe congestive heart failure and expired in the hospital a week later. In this group of 11 patients, three succumbed and most of the others are currently totally debilitated at rest (NYHA Class IV). Long-term follow-up of the surgically managed patients (1 to 15 years) shows that ten patients improved from NYHA functional Class IV to either I or II, another patient from Class III to Class I, and a final patient was only minimally improved.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1996

Preoperative cardiac risk assessment with adenosine stress dual-isotope myocardial single-photon emission computed tomography.

BACKGROUND: Previous studies have demonstrated that pharmacologic stress thallium-201 (201Tl) myocardial scintigraphy is a useful tool to evaluate preoperative cardiac risk. HYPOTHESIS: The purpose of this study was to assess the utility of adenosine stress dual-isotope [rest 201Tl/stress technetium-99m (99mTc) sestamibi] myocardial single-photon emission computed tomography (SPECT) in predicting the risk of perioperative cardiac events (unstable angina, myocardial infarction, cardiac death) in patients undergoing major noncardiac surgery. METHODS: We evaluated 43 consecutive patients (20 men, 23 women, mean age 64 years, range 30-83 years) within 8 weeks prior to major noncardiac surgery requiring general anesthesia. SPECT imaging was performed with 111 MBq (3 mCi) 201Tl at rest and 925 MBq (25 mCi)99mTc sestamibi during adenosine stress. RESULTS: Of the 43 patients, 15 (35%) had stress-induced ischemia and 28 (65%) did not. Perioperative cardiac events occurred in 4 (27%) of the 15 patients with stress-induced ischemia (2 unstable angina, 2 nonfatal myocardial infarctions) and in none of the 28 patients without inducible ischemia (p = 0.02). CONCLUSION: Adenosine stress dual-isotope myocardial SPECT is useful in determining the preoperative cardiac risk of patients undergoing major noncardiac surgery.

Adenosine↗

PubMed2004

Aortic valve replacement with 31- and 33-mm mechanical prostheses: early results.

The mean aortic diameter of Indian adults is 25-31 mm, yet fewer than 1% of worldwide heart valve procedures involve a 31-mm aortic heart valve. Of the 72 large prosthetic aortic valves (31-mm) implanted in the Asia Pacific region during 2001-2003, 53 (74%) were implanted at our institution. This retrospective study was undertaken to assess early results and outcomes, on echocardiography and exercise testing, in patients who received large prosthetic aortic valves. From January 1997 through December 2002, 27 patients underwent isolated aortic valve replacement with 31-mm St. Jude Medical prostheses, and 4 patients underwent aortic valve replacement with 33-mm St. Jude Medical reversed mitral prostheses. These 31 patients were among 240 who underwent isolated aortic valve replacement at our institution during the same period. The preoperative, perioperative, and postoperative data were collected from case records and patient follow-up. Fifteen of the 31 patients underwent echocardiography and exercise testing at least 6 months after operation. There were no early deaths. No patient developed prosthetic valve endocarditis or paravalvular leak. One patient, who developed valve thrombosis as a result of noncompliance with the anticoagulation regimen, underwent thrombectomy and died during the early postoperative period, due to low cardiac output. There was no structural failure or anticoagulant-related hemorrhage. Postoperatively, the peak and mean gradients across the prostheses were low. The exercise performance of all the patients was good. These early favorable results need to be borne out by longer and more comprehensive study of larger groups.

Adolescent↗

PubMed2000

Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. A randomized, controlled trial.

BACKGROUND: In publicly funded health care systems, a waiting period for such services as coronary artery bypass graft surgery (CABG) is common. The possibility of using the waiting period to improve patient outcomes should be investigated. OBJECTIVE: To examine the effect of a multidimensional preoperative intervention on presurgery and postsurgery outcomes in low-risk patients awaiting elective CABG. DESIGN: Randomized, controlled trial. SETTING: A regional cardiovascular surgery center in a tertiary care hospital, southwestern Ontario, Canada. PATIENTS: 249 patients on a waiting list for elective CABG whose surgeries were scheduled for a minimum of 10 weeks from the time of study recruitment. INTERVENTION: During the waiting period, the treatment group received exercise training twice per week, education and reinforcement, and monthly nurse-initiated telephone calls. After surgery, participation in a cardiac rehabilitation program was offered to all patients. MEASUREMENTS: Postoperative length of stay was the primary outcome. Secondary outcomes were exercise performance, general health-related quality of life, social support, anxiety, and utilization of health care services. RESULTS: Length of stay differed significantly between groups. Patients who received the preoperative intervention spent 1 less day [95% CI, 0.0 to 1.0 day] in the hospital overall (P = 0.002) and less time in the intensive care unit (median, 2.1 hours [CI, -1.2 to 16 hours]; P = 0.001). During the waiting period, patients in the intervention group had a better quality of life than controls. Improved quality of life continued up to 6 months after surgery. Mortality rates did not differ. CONCLUSION: The waiting period for elective procedures, such as CABG, may be used to enhance in-hospital and early-phase recovery, improving patients' functional abilities and quality of life while reducing their hospital stay.

Anxiety↗

PubMed1994

Effects of cardiac transplantation on bioenergetic abnormalities of skeletal muscle in congestive heart failure.

BACKGROUND: Patients with advanced heart failure have bioenergetic abnormalities of skeletal muscle metabolism during exercise. Using 31P magnetic resonance spectroscopy, we sought to determine whether skeletal metabolic responses to exercise are normalized by orthotopic cardiac transplantation. METHODS AND RESULTS: Four groups were studied: healthy normal volunteers (n = 9), subjects awaiting heart transplantation (n = 10), subjects < 6 months (mean, 4 months) after transplant (n = 9), and subjects > 6 months (mean, 15 months) after transplant (n = 8). None of the posttransplant patients had biopsy evidence of rejection at the time of study. There were no significant differences in age, preoperative functional class, or symptom duration among the three patient groups. Metabolic responses were monitored in the dominant arm during incremental weight pull exercise and 10 minutes of recovery by 31P magnetic resonance spectroscopy, with measurement of pH and the phosphocreatine (PCr)/(PCr + inorganic phosphate [Pi]) ratio, an index of PCr concentration. In addition, based on recovery data, the rate of PCr resynthesis was calculated as a measure of oxidative metabolism that is independent of work level, recruitment, or muscle mass, and the effective maximal rate of mitochondrial ATP synthesis (Vmax) was determined. Analysis was by ANOVA. There were no differences between groups in pH or PCr/(PCr + Pi) at rest. Compared with the normal control group, the pretransplant group had a decreased exercise duration (11.3 +/- 2.5 versus 15.0 +/- 1.3 minutes, P = .02), a lower submaximal exercise PCr/(PCr + Pi) ratio (0.58 +/- 0.11 versus 0.76 +/- 0.08, P < .05), a reduced PCr resynthesis rate (13 +/- 6 versus 22 +/- 9 mmol/L per minute, P < .05), and a lower calculated Vmax (26 +/- 14 versus 53 +/- 26 mmol/L per minute, P < .05). In the group studied early after transplantation, all the changes noted in the pretransplant group persisted and were if anything somewhat worse. In the group studied late after transplantation, there was a significant improvement in the PCr resynthesis rate compared with the early-posttransplant group (27 +/- 6 late versus 15 +/- 6 mmol/L per minute early, P < .05) and statistically nonsignificant trends toward improvements in submaximal exercise pH (6.86 +/- 0.24 late versus 6.72 +/- 0.24 early) and submaximal PCr/(PCr + Pi) ratio (0.56 +/- 0.14 late versus 0.44 +/- 0.15 early) and Vmax (45 +/- 21 late versus 33 +/- 15 mmol/L per minute early). However, compared with normal subjects, exercise duration and submaximal PCr/(PCr + Pi) were still reduced in the late-posttransplant group. CONCLUSIONS: Despite successful heart transplantation, skeletal muscle abnormalities of advanced heart failure persist for indefinite periods, although partial improvement occurred at late times. The persistent abnormalities may contribute to the reduced exercise capacity that is present in most patients after transplantation.

Energy Metabolism↗

PubMed1997

Cardiorespiratory responses to exercise after repair of the univentricular heart.

The purpose of this study is to evaluate cardiorespiratory responses to exercise in patients with univentricular heart according to the type of repair used. Forty-three patients with univentricular heart were divided into three groups: 15 preoperative patients (group A), 18 who had Fontan repair (group B) and 10 who had ventricular septation (group C). Group C was further divided into two subgroups, 7 with normal atrioventricular valve function (group C1) and 3 with atrioventricular valve regurgitation (group C2). Cardiorespiratory variables were determined after performance of cardiopulmonary exercise testing. One-hundred-and-twenty-five healthy subjects, age 5-26 years, served as controls. Oxygen uptake in group C1 at both ventilatory threshold and peak exercise was highest in all groups of univentricular heart (P < 0.05), while peak oxygen uptake in group C1 was significantly lower vs controls (P < 0.001), and that in group B was significantly higher than that for group A. Although chronotropic incompetence was noted in all groups of univentricular heart, marked improvements in both the relationship between heart rate and oxygen uptake and in the ventilatory efficiency were observed after definitive repair. While ventilatory efficiency was still impaired in group B, there was no significant difference between that in group C1 and the control group. When patients with univentricular heart of the left ventricular type (Van Praagh's type A single ventricle) were analyzed separately, superior cardiorespiratory response after ventricular septation was also found. In view of these findings, the ventricular septation procedure is preferred to the Fontan method in patients with univentricular heart when morphological conditions are suitable for this procedure so as not to make residual complications, such as significant atrioventricular valve regurgitation.

Adolescent↗

PubMed2006

Factors affecting exercise capacity in renal transplantation candidates on continuous ambulatory peritoneal dialysis therapy.

It is well known that reduced peak oxygen uptake (peak VO2) is a predictor for mortality in several chronic diseases and during the preoperative period. The aim of this study was to investigate the factors that influence peak VO2 in renal transplant candidates receiving continuous ambulatory peritoneal dialysis (CAPD) therapy. We included 22 chronic renal failure patients (12 men, 10 women; ages 29.64 +/- 8.29 years; CAPD duration, 37.35 +/- 7.15 months) in this study. Pulmonary function tests and symptom-limited cardiopulmonary exercise tests were administered to all patients. Cardiopulmonary exercise tests were performed on a cycle ergometry at the same time of day for all patients. We analyzed the exercise duration, maximum work rate, and peak VO2 level during cycle ergometry. Serum hemoglobin, hematocrit, total cholesterol, triglyceride, blood urea nitrogen, creatinine, albumin, prealbumin, C-reactive protein, sedimentation rate, ferritin, sodium, potassium, parathyroid hormone, calcium, and phosphorus levels were analyzed from samples. Mean values of exercise duration (6.86 +/- 1.56 minutes), peak VO2 (17.20 +/- 4.91 mL/min/kg), and maximum work rate (77.09 +/- 26.09 watts) were lower when we compared them with predicted values for a healthy population. Peak VO2 was well correlated with serum phosphorus levels (4.51 +/- 1.28 mg/dL, r = .592, P = .004). Test duration was correlated with peak VO2 (r = .489, P = .025) and serum phosphorus levels (r = .530, P = .024). There were no significant correlations with other factors. As a component of ATP, phosphorus is at the hub of the energy-related mechanisms operative in muscles of the respiratory and musculoskeletal systems. Therefore, we suggest that low exercise capacity might be related to low serum phosphorus levels, and that optimal control of serum phosphorus therapy would increase exercise capacity, exercise duration, and oxygen consumption resulting in a decrease of postoperative mortality in renal transplantation candidates.

Adult↗

PubMed1981

Improvement of left ventricular exercise hemodynamic function after aorta-coronary artery bypass grafting.

In 39 patients with coronary artery disease and angina pectoris, exercise hemodynamic evaluation, left ventriculography, and coronary arteriography were performed both before and 3 to 36 months (mean 17 months) after aorta-coronary artery bypass grafting. Of the 32 patients with abnormal exercise hemodynamic responses before operation, 11 returned to normal at the postoperative study (Group N) and 21 remained abnormal (Group A). Preoperative characteristics (mean age, functional class, prior myocardial infarction, left ventriculographic appearance, mean ejection fraction, and mean number of vessels diseased) were similar in the two groups. Of the perioperative and postoperative characteristics examined (mean number of grafts, operative myocardial infarction, postoperative functional class, treadmill test result, and adequacy of left coronary artery revascularization), only the adequacy of left coronary artery revascularization differed between Groups N and A. Eight of 11 Group N and only three of 20 Group A patients had complete revascularization, with patent grafts, of the left coronary artery. We conclude that improved exercise hemodynamic function does occur in some patients after aorta-coronary artery bypass operations. Such improvement is most likely when all major lesions of the left coronary artery are completely revascularized.

Coronary Artery Bypass↗