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Aortocoronary-Artery Bypass: Title and subTitle BreakAssessment After 13 Years FREE

Michael E. DeBakey, MD; Gerald M. Lawrie, MD
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Reprint requests to Baylor College of Medicine, Texas Medical Center, Houston, TX 77030 (Dr DeBakey).


JAMA. 1978;239(9):837-839. doi:10.1001/jama.1978.03280360033013
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DURING the past ten years, as aortocoronary-arterybypass operation has received wider application, the procedure has been subjected to possibly the most intensive scrutiny of any operation in the history of surgery. The recent preliminary report of a Veterans Administration Cooperative Study,1 highly publicized in the lay press, has not only created considerable controversy within the medical profession, but has also caused confusion and concern cmong patients. Unfortunately, an editorial accompanying this report has been erroneously interpreted as a total condemnation of the surgical treatment of coronary arterial disease.2 That the preliminary study of a small, highly selective group of patients operated on by surgeons with variable experience and observed for a mean interval of only 21 months should have received such enormous attention indicates the passion and partisanship that have enveloped this subject.

In the 13 years since the first successful aortocoronary-artery—bypass graft was performed for coronary atherosclerosis,

REFERENCES

Murphy ML, Hultgren HN, Detre K, et al:  Treatment of chronic stable angina: A preliminary report of survival data of the randomized Veterans Administration Cooperative Study . N Engl J Med 297:621-627, 1977;.
Braunwald E:  Coronary-artery surgery at the crossroads . N Engl J Med 297:661-663, 1977;.
Garrett HE, Dennis EW, DeBakey ME:  Aortocoronary bypass with saphenous vein graft: Seven-year follow-up . JAMA 223:792-794, 1973;.
Mundth ED, Austen WG:  Surgical measures for coronary heart disease . N Engl J Med 293:13-19, 75-80, 124-130, 1975;.
Mathur VS, Guinn GA:  Prospective randomized study of coronary bypass surgery in stable angina: The first 100 patients . Circulation 52( (suppl 1) ):133-139, 1975;.
Goldberg AD, Crawley JCW, Raftery EB, et al:  Myocardial blood flow following saphenous vein bypass surgery . Circulation 52( (suppl 1) ):215-219, 1975;.
Selden R, neill WA, Ritzmann LW, et al:  Medical versus surgical therapy for acute coronary insufficiency: A randomized study . N Engl J Med 293:1329-1333, 1975;.
Korbuly DE, Formanek A, Gypser G, et al:  Regional myocardial blood flow measurements before and after coronary bypass surgery: A preliminary report . Circulation 52:38-45, 1975;.
Dunkman WB, Perloff JK, Kastor JA, et al:  Medical perspectives in coronary artery surgery—a caveat . Ann Intern Med 81:817-837, 1974;.
Balcon R, Honey M, Rickards AF, et al:  Evaluation by exercise testing and atrial pacing of results of aorto-coronary bypass surgery . Br Heart J 36:841-853, 1974;.
Lawrie GM, Morris GC Jr, Chapman DW, et al:  Patterns of patency of 596 vein grafts up to seven years after aorto-coronary bypass . J Thorac Cardiovasc Surg 73:443-448, 1977;.
Lawrie GM, Morris GC Jr, Howell JF, et al:  Results of coronary bypass more than 5 years after operation in 434 patients: Clinical, treadmill exercise, and angiographic correlations . Am J Cardiol 40:665-672, 1977;.
Sheldon WC, Rincon G, Effler DB, et al:  Vein graft surgery for coronary artery disease: Survival and angiographic results in 1,000 patients . Circulation 48( (suppl 3) ):184-189, 1973;.
Rimm AA, Barboriak JJ, Anderson AJ, et al:  Changes in occupation after aortocoronary vein-bypass operation . JAMA 236:361-364, 1976;.
David P:  Contributing factors preventing return to work of cardiac surgery patients , in The First Decade of Bypass Graft Surgery for Coronary Artery Disease . Cleveland, Cleveland Clinic Foundation, 1977;, p 133.
Takaro T, Hultgren HN, Detre KM:  VA cooperative study of coronary arterial surgery: II. Left main disease , abstracted. Circulation 52( (suppl 2) ):143, 1975;.
Detre K, Hultgren H, Takaro T:  Veterans Administration Cooperative Study of surgery for coronary arterial occlusive disease: III. Methods and baseline characteristics, including experience with medical treatment . Am J Cardiol 40:212-225, 1977;.
Morris GC Jr, Reul GJ, Howell JF, et al:  Follow-up results of distal coronary artery bypass for ischemic heart disease . Am J Cardiol 29:180-185, 1972;.
Conley MJ, Wechsler AS, Anderson RW, et al:  The relationship of patient selection to prognosis following aortocoronary bypass . Circulation 55:158-163, 1977;.
Read R, Hultgren H, Detre K, et al:  Preliminary survival data following a randomized trial of aorto-coronary saphenous vein bypass . Read before the American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 20, 1977 .
Scheidt SS:  Unstable angina: Medical management—or surgery? Cardiovasc Med 2:541-543, 1977;.
DeBakey ME, McCollum CH III:  Coronary artery bypass procedures . Compr Ther 1:14-19, 1975;.

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Murphy ML, Hultgren HN, Detre K, et al:  Treatment of chronic stable angina: A preliminary report of survival data of the randomized Veterans Administration Cooperative Study . N Engl J Med 297:621-627, 1977;.
Braunwald E:  Coronary-artery surgery at the crossroads . N Engl J Med 297:661-663, 1977;.
Garrett HE, Dennis EW, DeBakey ME:  Aortocoronary bypass with saphenous vein graft: Seven-year follow-up . JAMA 223:792-794, 1973;.
Mundth ED, Austen WG:  Surgical measures for coronary heart disease . N Engl J Med 293:13-19, 75-80, 124-130, 1975;.
Mathur VS, Guinn GA:  Prospective randomized study of coronary bypass surgery in stable angina: The first 100 patients . Circulation 52( (suppl 1) ):133-139, 1975;.
Goldberg AD, Crawley JCW, Raftery EB, et al:  Myocardial blood flow following saphenous vein bypass surgery . Circulation 52( (suppl 1) ):215-219, 1975;.
Selden R, neill WA, Ritzmann LW, et al:  Medical versus surgical therapy for acute coronary insufficiency: A randomized study . N Engl J Med 293:1329-1333, 1975;.
Korbuly DE, Formanek A, Gypser G, et al:  Regional myocardial blood flow measurements before and after coronary bypass surgery: A preliminary report . Circulation 52:38-45, 1975;.
Dunkman WB, Perloff JK, Kastor JA, et al:  Medical perspectives in coronary artery surgery—a caveat . Ann Intern Med 81:817-837, 1974;.
Balcon R, Honey M, Rickards AF, et al:  Evaluation by exercise testing and atrial pacing of results of aorto-coronary bypass surgery . Br Heart J 36:841-853, 1974;.
Lawrie GM, Morris GC Jr, Chapman DW, et al:  Patterns of patency of 596 vein grafts up to seven years after aorto-coronary bypass . J Thorac Cardiovasc Surg 73:443-448, 1977;.
Lawrie GM, Morris GC Jr, Howell JF, et al:  Results of coronary bypass more than 5 years after operation in 434 patients: Clinical, treadmill exercise, and angiographic correlations . Am J Cardiol 40:665-672, 1977;.
Sheldon WC, Rincon G, Effler DB, et al:  Vein graft surgery for coronary artery disease: Survival and angiographic results in 1,000 patients . Circulation 48( (suppl 3) ):184-189, 1973;.
Rimm AA, Barboriak JJ, Anderson AJ, et al:  Changes in occupation after aortocoronary vein-bypass operation . JAMA 236:361-364, 1976;.
David P:  Contributing factors preventing return to work of cardiac surgery patients , in The First Decade of Bypass Graft Surgery for Coronary Artery Disease . Cleveland, Cleveland Clinic Foundation, 1977;, p 133.
Takaro T, Hultgren HN, Detre KM:  VA cooperative study of coronary arterial surgery: II. Left main disease , abstracted. Circulation 52( (suppl 2) ):143, 1975;.
Detre K, Hultgren H, Takaro T:  Veterans Administration Cooperative Study of surgery for coronary arterial occlusive disease: III. Methods and baseline characteristics, including experience with medical treatment . Am J Cardiol 40:212-225, 1977;.
Morris GC Jr, Reul GJ, Howell JF, et al:  Follow-up results of distal coronary artery bypass for ischemic heart disease . Am J Cardiol 29:180-185, 1972;.
Conley MJ, Wechsler AS, Anderson RW, et al:  The relationship of patient selection to prognosis following aortocoronary bypass . Circulation 55:158-163, 1977;.
Read R, Hultgren H, Detre K, et al:  Preliminary survival data following a randomized trial of aorto-coronary saphenous vein bypass . Read before the American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 20, 1977 .
Scheidt SS:  Unstable angina: Medical management—or surgery? Cardiovasc Med 2:541-543, 1977;.
DeBakey ME, McCollum CH III:  Coronary artery bypass procedures . Compr Ther 1:14-19, 1975;.
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