Differentiated Approach to the Surgical Treatment of Patients with Recurrent Angina after CABG

The most of the patients with recurrent angina after CABG need repeated interventions often involving a high risk of fatal complications.

206 from the 538 analyzed patients were included in the study. According to the endovascular myocardial revascularization strategy the patients were divided in two groups.

The I group included 98 patients (47%) who had percutaneous coronary intervention (PCI) of the native artery. And the II group included 56 patients (27%) who had PCI of the bypass. 52 (26%) patients who had unsuccessful PCI are recommended for heart surgeon consultation for re-CABG.

Short-term results: the hospital mortality rate was 0% in both groups, the number of non-fatal myocarial infarction - 4% and 1.8%; stent thrombosis - 3%, 0%; perforation of the coronary artery – 1%, 0%, respectively in groups I and II. Long therm results (18-36 months): the mortality rate was also 0%, the non-fatal myocardial infarction – 1%, 3,6%; the repeated interventions on the target vessel – 13,3%, 32,1%, respectively in groups I and II.

The created algorithm of endovascular myocardial revascularization based on the identification of risk factors for intervention and differentiated approach to the surgical treatment makes it possible to increase the effectiveness of endovascular interventions in patients with recurrent angina after previous CABG. The tactic of the native artery revascularization is preferable in equivalent lesions of the native artery and bypass, however, in the presence of a more severe lesion of the native artery, tactic of the bypass revascularization should be used.