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November 10, 1978

Coronary Artery Surgery

Author Affiliations

Columbia Physicians Center Evansville, Ind

JAMA. 1978;240(20):2199-2200. doi:10.1001/jama.1978.03290200077039

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Some descriptive simplifications— like the concept that patients with coronary disease have either single-, double-, or triple-vessel involvement—plainly distort reality. Nature, it seems, has created "coronary arteries as variable as fingerprints." This gap between conceptualization and reality raises an important question. How can we intelligently select patients for coronary surgery if each individual does not accurately fit into the categories we have so far defined and analyzed?

To lift one corner of the verbal veil that has hid the answer, the authors start by altering our perception of coronary disease distribution. After discarding the standard diagram of coronary arteries (in favor of a handdrawn sketch of each patient's peculiar anatomy and pattern of disease), the authors present fascinating detail on all phases of bypass surgery: the clinical indications; angiography and its interpretation; preoperative education, evaluation, and preparation; informed consent; anesthetic and operative techniques; and postoperative management.

Throughout, the discussion achieves