[Recurrence of stenocardia after aortocoronary bypass and the possibility of repeated myocardial revascularization]

Abstract

The causes of angina pectoris recurrences after aortocoronary bypass surgery have been studied. Indications for repeated myocardial revascularization and the possibilities for its performance have been analyzed. The long-term results of aortocoronary bypass surgery performed in 358 patients were evaluated at 30 months, on the average, after the operation. A gradual rise in the rate of angina recurrences was noted mostly within the first postoperative year. Repeated coronary angiography with bypass contrasting was done in 100 patients, 37 of whom presented angina recurrence. Impaired patency of the aortocoronary bypass was found to be the major cause of a recurrence (83.8%), this could be secondary to bypass thrombosis, fibrous hyperplasia of the graft intima, and atherosclerosis. Among other causes were incomplete revascularization of the myocardium and progression coronary atherosclerosis. All patients with pronounced angina pectoris were recommended repeated coronary angiography with bypass contrasting to specify indications for operation and possibilities for its performance. It was noted, that repeated revascularization may be hindered not by a factor responsible for the current recurrence, but primarily by the poor status of the distal portion of the diseased arteries due to diffuse atherosclerosis.