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William F. Northrup, III
Robert W. Emery
Demetre M. Nicoloff
Theodore J. Lillehei
Arlen R. Holter
David P. Blake
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Ann Thorac Surg 2004;77:488-495
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Opposite trends in coronary artery and valve surgery in a large multisurgeon practice, 1979–1999

William F. Northrup, III, MDa*, Robert W. Emery, MDa, Demetre M. Nicoloff, MDa, Theodore J. Lillehei, MDa, Arlen R. Holter, MDa, David P. Blake, MDa

a Cardiac Surgical Associates, P.A., St. Paul, Minnesota, USA

Accepted for publication July 21, 2003.

* Address reprint requests to Dr Northrup, Cardiac Surgical Associates, P.A., 2356 University Ave W, Suite 258, St. Paul, MN 55407, USA.
e-mail: north7{at}earthlink.net

BACKGROUND: Trends in coronary artery bypass (CAB) and valve operations (VO) may help predict the future of cardiac surgery in the context of changing case mix, shifting paradigms, emerging technology, and population demographics.

METHODS: We retrospectively reviewed all 30,319 adult CAB and VO in our group from 1979 to 1999 according to specific procedures.

RESULTS: Coronary artery bypass volumes peaked in 1996 at 1,895 cases, declining 15.3% to 1,605 cases in 1999 with a decrease in risk profile and percent reoperations and an increase in mean age and percent octogenarians, prior percutaneous coronary interventions (PCI), left internal mammary artery (LIMA) graft usage, off-pump technology usage, and hospital mortality of reoperations. Right internal mammary grafts were employed infrequently and radial artery grafts transiently. Overall VO volumes continued to increase 24.0% since 1996, from 470 to 583 cases with a decreased risk profile, increased mean age, and percent octogenarians and prior PCI. The percentage of mechanical valve implants decreased, while the percentage of various tissue solutions for valve disease increased. Limited access incisions and port-access were employed transiently with CAB and VO.

CONCLUSIONS: Coronary artery bypass volumes are decreasing, with an increasing percentage of LIMA grafts and off-pump cases. Valve operation volumes are steadily increasing, with a decreasing percentage of mechanical valve implants, in favor of various tissue solutions.




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