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A retrospective study of 185 cases of left main coronary artery stenosis operated between 1980-01-01 and 1991-06-15 at the Limoges University Hospital Center was performed. The influence of operative procedures: cardiopulmonary bypass and aortic cross clamping times, type and number of coronary grafts, time between coronary surgery and coronary angiography, on early (before the 30th days after surgery) and late postoperative vital prognosis was studied. This study confirms in our study the poor early postoperative prognosis of: 1) cardiopulmonary bypass time over 140 min; 2) coronary bypasses in an emergency context (surgery less than 24 h after coronary angiography); 3) incomplete coronary revascularization. The nature of grafts and the aortic cross clamping time have no influence. The actuarial survival studies confirm the poor long-term postoperative prognosis of incomplete coronary revascularization; the other surgical procedures have no influence.

The favourable clinical results of cardiac transplantation merit wider application of this therapeutic measure in the management of non-obstructive primary cardiomyopathies and diffuse myocardial fibrosis secondary to coronary artery disease and in its terminal phase, in the absence of any absolute contraindication (pulmonary resistance too high, diabetes, gastrointestinal disorder, infection, patient too old.). Close cooperation between departments of cardiology and surgical transplantation centres, with systematic study of the patients pre-operatively and the setting up of a waiting list of recipients, will make possible in the future the improvement of the already encouraging results of cardiac transplantation.