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  • Title: [Surgical treatment of acute coronary heart disease].
    Author: Grädel E.
    Journal: Schweiz Med Wochenschr Suppl; 1984; 16():38-43. PubMed ID: 6610937.
    Abstract:
    The main and most attractive surgical measure in acute coronary disease is emergency revascularisation of acute ischemia. As far as unstable angina is concerned, the recommendations of the National Cooperative Study Group are more or less universally accepted, which means that emergency revascularisation is reserved for patients in whom stabilisation of angina with vigorous medical treatment is unsuccessful. On the other hand, it has been shown that a large proportion of patients in whom unstable angina had been successfully stabilized subsequently suffered from severe chronic angina. The author therefore recommends performing coronarography in all younger patients within a few days. If left main stem or three-vessel disease is documented by this investigation, aortocoronary bypass should be performed during the same hospitalisation. In cases with isolated proximal stenosis of the left anterior descending artery, transluminal dilatation should be considered. The author's own results confirm the general experience that revascularisation for unstable angina does not involve elevated risk. After established acute infarction, the role of surgery is confined to treatment of severe mechanical complications of infarction (acute aneurysm, ventricular septal defect, subvalvular mitral insufficiency) and aortocoronary bypass for postinfarction angina. The author's results show that early and late mortality are rather high, though a good late result can be achieved in about 50% of the cases. However, in view of the poor prognosis under conservative treatment, even this modest rate of success seems acceptable.
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