Surgical management of complex acquired cardiovascular disease

The surgical techniques for repair of left ventricular aneurysms, mitral valve insufficiency, and closure of postinfarction ventricular septal defects are well standardized and attended by resonably good early success rates. However, as with peripheral vascular disease, late perioperative mortality still occurs secondary to reinfarction, and late survival remains subnormal for the same reasons. Thus, like others, we have favored the addition of coronary bypass grafts whenever feasible when performing these procedures. Acute myocardial infarction had been recognized as the major cause of early and late mortality in cardiovascular surgery for atherosclerosis long before the advent of coronary surgery. Since its advent, the use of coronary bypass procedure prior to or during the correction of other major lesions has led to substantial improvement in the early and late results of therapy in these seriously ill patients.