A study has been made of 165 patients with arteriosclerotic heart disease who underwent 200 major surgical procedures. An analysis has been included of the reports from several other clinics concerning the risk of surgery in the aged and in patients with arteriosclerotic heart disease. From these combined data the following statements appear to be justified: 1. 1. Mortality and morbidity rates are two to three times greater among cardiac patients subjected to operation than among the total operated population. 2. 2. The symptomatic manifestations of myocardial disease do not influence the mortality significantly, with the exception of congestive heart failure and recent infarction. Patients with angina pectoris, hypertension or healed myocardial infarction are not greater surgical risks than are those in whom the diagnosis of arteriosclerotic heart disease is made without symptoms being present. Conversely these findings emphasize the importance of handling the asymptomatic cardiac patient as carefully as one having symptoms, when operation is being considered or undertaken. 3. 3. The increased risk of surgery in the aged is due in large part but not entirely to the presence of arteriosclerotic heart disease. This statement is supported by the finding that, although mortality rates are significantly greater in patients over seventy years of age as compared with those of younger patients when age alone is considered, such age differences lose much of their statistical significance when all in the study group have heart disease. That other diseases, which are more likely to be present in older patients, also exert an influence is suggested by the observation that the mortality rate was greater for the aged group than for patients of all ages having arteriosclerotic heart disease. 4. 4. Operative risk is not influenced by the choice of the anesthetic agent employed. 5. 5. Although alterations in blood pressure during operation should be avoided if possible, the occurrence of hypotension for short periods of time is not necessarily associated with catastrophic sequelae. Furthermore, a stable blood pressure during operation does not eliminate the possibility of a myocardial infarction appearing in the postoperative period.
ASJC Scopus subject areas