Long-term of patients receiving an aorto-bi-femoral prosthesis for atherosclerotic occlusive disease of the aortic bifurcation.

Over a 14-year period (1975-1989), 547 patients with a mean age of 57 years received an aorto-bi-femoral prosthesis for atherosclerotic occlusive disease (AOD) and underwent regular follow-up over a 13-year period. Immediate post-operative mortality was 2.5% with few deaths due to cardiovascular causes (0.5%). The long-term mortality was significantly elevated at 5 years (10% higher than controls) and at 10 years (16%). These deaths were due to the AOD and its surgical treatment (10%), other cardiovascular disease (30%) and cancer (41%). Approximately 5% of patients required an immediate post-operative, or delayed amputation, compared to 33% which had a threatened limb before the operation. Thrombosis of the prosthesis was relatively rare. At 5 years, 81% of the survivors remained largely improved; at 10 years, 67% and at 13 years, 62%. The benefit of this intervention is therefore unquestionable with regards to the functional state and survival. Also, in avoiding immobility due to the disabling intermittent claudication or amputation, it considerably improves the quality of life which largely compensates for the low mortality rates and subsequent complications of the prosthesis.

[Long-term clinical results of coronary surgery. Apropos of 400 patients followed for 5 to 11 years]. / Les résultats cliniques à long terme de la chirurgie coronaire. A propos de 400 malades suivis de 5 à 11 ans.

Between 1976 and 1982 four hundred consecutive patients underwent coronary artery bypass surgery and were operated by the same surgical team: 345 men (88.5%) and 46 women (11.5%). The average age was 56 years (7.5% were over 75 years of age); 86% of patients were infunctional classes III and IV; 46% had triple vessel disease and 9.25% had severe stenosis of the left main stem. Left ventricular ejection fractions were decreased in 26% and very poor in 4.5% of patients. The average number of bypass grafts was 1.72 per patient and the operative mortality was 3.5%. The 10 year survival rate was 81% and 75% of these patients still thought that their condition had been improved by surgery although only 30% were completely asymptomatic and had had no further coronary event. A comparison with a control population of the same age showed better survival in the surgical group in patients surviving operation. Contrary to traditional thinking, the surgical patients suffered relatively few deaths of cardiac causes but as many, if not more, of cancer. The operated patients died of approximately the same diseases as the control population of the same age but in lower proportions for each cause of death (17 cardiovascular deaths in the control population compared with 13 in the operated group; 18 versus 10 deaths of cancer, and 18 versus 8 deaths of other causes in the control and operated patients, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)