Percutaneous Transluminal Coronary Angioplasty in Patients with Failed Bypass Graft Surgery

Abstract

The problem of patients with recurrent anginal pain following successful coronary bypass graft surgery is a growing one with important consequences. Coronary bypass surgery is now being performed on approximately 200000 patients per year in the United States, a fairly constant number over the past 5–7 years [1]. Over this period the age of patients receiving primary operations has steadily risen. The mean age of patients undergoing primary operation has increased from 53 in the early 1970s to 58 in the early 1980s and continues to rise [2]. Thus, many patients with failed bypass graft surgery due to vein graft atherosclerosis are now in their late 60s or 70s. Because of the increased risk and diminished efficacy of repeat bypass surgery and the diminished efficacy of percutaneous transluminal coronary angioplasty (PTCA) in patients with old vein grafts, elderly patients with prior bypass surgery are subjected to aggressive medical therapy. With increased use of PTCA in younger patients with symptomatic angina, it has been the older patient with failed surgery who has supplied the clinical material for young cardiologists to learn the value of medical therapy.