Redo coronary bypass infarction after acute coronary syndrome in the working heart

Jalilov Adkham Kakhramonovich

Currently, the operation of coronary artery bypass grafting is undoubtedly a highly effective method of treating patients with coronary artery disease. This method of myocardial revascularization in most cases allows achieving a stable improvement in the quality and an increase in the life expectancy of operated patients [1]. After primary myocardial revascularization, the likelihood of a patient requiring repeated coronary artery bypass grafting depends on patient-related indicators, indicators associated with primary surgery, the possibility of alternative treatment, expert opinion on the possibility of repeated myocardial revascularization and the time of its implementation [2]. The time of occurrence of relapse of angina pectoris is determined by the peculiarities of the clinic before the primary surgery, the presence or absence of post infarction cardiosclerosis, the prevalence and localization of stenosing lesions of the coronary arteries, concomitant pathology (arterial hypertension, dyslipidemia, diabetes mellitus, obesity II - III degree, etc.). Persistence of signs of instability before surgery, early post infarction angina pectoris, circulatory failure significantly worsen the prognosis of CABG [3]. The likelihood of a poor prognosis increases as the left ventricular ejection fraction decreases. Patients with acute coronary syndrome who have undergone myocardial revascularization and who are candidates for reoperation are increasing every year]. According to Research at the Cleveland Clinic, in the early years of coronary surgery (1967 to 1978), only 28% of patients underwent a second coronary bypass surgery solely for shunt thrombosis, and that shunt thrombosis often occurred early after primary surgery (mean postoperative interval 28 months after primary surgery). From 1967 to 1978, 55% of patients operated on for coronary artery disease were repeatedly subjected to coronary artery bypass grafting due to the progression of atherosclerosis in non-bypass coronary arteries. Today, early graft damage and disease progression in unshunted vessels are not the main reasons for reoperation. Patients who have undergone reoperation have special, more complex pathologies. Atherosclerosis of venous shunts is present in most patients and is one of the leading and most dangerous diseases of conduits. The first case of successful repeated myocardial revascularization in a patient with recurrent angina pectoris after previously performed mammary-coronary bypass grafting is presented to our attention. Authors' contributions.

Keywords:acute coronary syndrome, coronary artery bypass grafting, repeated myocardial revascularization.