Features of coronary artery bypass grafting in young patients with acute coronary syndrome

Abstract

Aim: Purpose of the study was retrospective analysis of hospital and early (up to six monthes after operation) results of the surgical myocardial revascularization in patients, third and fourth decates of life, with acute coronary syndrome. Material and Methods: Since 2012 year up to November, 2018 year in CCH by the same brigade, performed 500 coronary artery bypass grafting operations in the patients with acute coronary syndrome, at the age of 30-83 years old, including 15 operations in patients ≤ 40 years old (3%). Clinical manifestation of acute coronary syndrome was presented: unstable angina in 13 (86.7%) patients, 6 (40%) of them with pass myocardial infarction in anamnesis; acute myocardial infarction, accompanied by S-T segment elevation (STEMI) in 2 (13.3%) patients. In coronarography: multivessel lesion of coronary arteries was revealed in 10 (66.7%) patients, 3 of them with lesion of trunk of the left coronary artery; bivascular lesion in 4 (26.7%) patients, single vessel lesion in 1 (6.6%). In 13 (86.7%) patients were performed coronary artery bypass grafting under the cardiopulmonary bypass (CPB). Average duration of the CPB= 127±9.66 min. Mean aortic clamp time = 68±6.91 min. Number of shunts for the whole group of 15 operated were from 1 to 5, at the average (3.28±0.31). In 6 patients (40%) performed three-branches CPB, in 5 patients (33.3%) fourth-branches, in 1 patient (6.7%) fifth-branches, in 2 patients (13.3%) double-branches and in 1 patient (6.7%) single branch CPB. Used conduits: left internal mammary artery in all 15 patients (100%), autovein in 12 (80%), radial artery in 10 (66.7%) patients. In last group with using radial artery, average amount of shunts was 1.5±0.1. Results: The structure of postoperative complications consist: low cardiac output syndrome in two patients; bleeding in 2 patients. In analyzed series, no lethal outcomes watched in duration up to 30 days after operation. All patients were watched during 6 monthes after discharge. It was not watches necessity for reinterventions and lethal outcomes. Conclusion: Hospital and immediate results of myocardial revascularization in young people with acute coronary syndrome very encouraging, while long-term results are not so optimistic and unsatisfactory. Therefor, considering the long life expectancy and higher functional and social demands of the patients at age ≤ 40 years, preference is given to hybrid interventions or isolated shunting using arterial conduits in both variants of revascularization.