Recurrent Angina following Coronary Artery Bypass Surgery Solutions In The Current Era

CORONARY artery bypass grafting is the most common cardiac surgical procedure performed all over the world. In patients with significant obstructive coronary artery disease, bypass grafting is performed primarily to relieve angina in those symptomatic despite medical therapy and also to improve life expectancy in those with particular anatomical substrate such as left main coronary artery disease, three vessel disease with left ventricular dysfunction, and two or three vessel disease with normal left ventricular function, provided there is significant disease of the proximal left anterior descending coronary artery. Undoubtedly, the most striking beneficial effect to the patient after a bypass surgery is the reduction in angina severity and frequency which occurs in atleast 8085% of survivors of surgery. Bypass surgery is clearly superior to medical therapy and was also to coronary angioplasty before the current methods of revascularization and drug eluting stents were available, at rendering the patient free of angina. More than 350,000 coronary artery bypass surgeries are performed per year in US alone and this number in India is estimated at about 30,000. It is definitely a much cheaper alternative to percutaneous intervention in multivessel coronary artery disease, because multiple devices and drug eluting stents will have to be used for complete revascularization [1-7]. Though coronary artery bypass surgery has stood the test of time, it has significant limitations, both in the immediate post operative period and in the long term, despite the fact that procedure related mortality in most standard centres is less than 2-3%. Peri operative myocardial infarction occurs in about 5-10% of patients undergoing bypass surgery and it is the most common cause of mortality. Overall incidence of peri operative stroke is 1-2%. Subtle or obvious cognitive impairment is detectable in a substantial number of survivors