J Korean Med Assoc.  2008 Apr;51(4):327-334. 10.5124/jkma.2008.51.4.327.

Coronary Artery Disease and Coronary Artery Bypass Surgery in Patients of Middle Age

• Lee YT
• Kim WS

• KMID: 2185741
• DOI: http://doi.org/10.5124/jkma.2008.51.4.327

Abstract

Coronary artery disease in young patients (< 40 years) is not common. However, when it occurs it has symptoms that are more frequent and a more rapid progression when compared to older affected patients. Younger patients are more likely to have normal coronary arteries and have nonobstructive disease < 70%, single-vessel disease and less extensive coronary artery atherosclerosis. Therefore, it is likely that there are differences in the cardiac risk factors in young patients undergoing coronary artery bypass surgery. Smoking, hypercholesterolemia, unstable angina, and myocardial infarction were more frequent in the young age group, and diabetes and hypertension were more common in older patients. The need for repeated interventions, additional surgery andlate myocardial infarction were more common in younger patients. Favorable factors associated with increased survival included the absence of unstable angina, a left ventricle ejection fraction of =45% and the use of the internal thoracic artery for procedures. The patency of saphenous vein grafts in younger patients was inferior to vein graft patency in the older patients. Risk factors such as hyperlipidemia, smoking and a family history of coronary artery disease may be related to the early graft failure in young patients. The patency of the internal thoracic artery to the left anterior descending artery was above 90% over 10 years; however, it was around 50% for the saphenous vein. Therefore, the aggressive use of internal thoracic arteries, for coronary artery bypass surgery in young patients, was essential for improved late survival and the event free survival (reduced additional interventions, surgeries and hospital admissions). The Ycomposite graft technique or sequential anastomosis, improves the coronary artery anastomosis with fewer arterial grafts. Other arterial grafts such as the gastroepiploic artery, radial artery and inferior epigastric artery could be used for coronary artery bypass surgery in young patients for free grafts, in situ grafts or Y-composite grafts. Young patients that have coronary artery bypass surgery have a favorable prognosis when the internal thoracic arteries or other arterial grafts are used. In addition, such as the Y-composite graft technique and sequential anastomosis can also be used with a high success rate.

Keyword

Coronary artery bypass grafting; Young age

MeSH Terms

Angina, Unstable
Arteries
Atherosclerosis
Coronary Artery Bypass
Coronary Artery Disease
Coronary Vessels
Disease-Free Survival
Epigastric Arteries
Gastroepiploic Artery
Heart Ventricles
Humans
Hypercholesterolemia
Hyperlipidemias
Hypertension
Mammary Arteries
Middle Aged
Myocardial Infarction
Prognosis
Radial Artery
Risk Factors
Saphenous Vein
Smoke
Smoking
Transplants
Veins
Smoke

Figure

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  Figure 1 Variable techniques of total arterial revascularization. (A) In situ LITA to left anterior descending artery (LAD), in situ RITA to distal right coronary artery (RCA), in situ GEA to posterolateral branch or obtuse marginal (OM) branch (B) In situ RITA to LAD, in situ LITA to OM (C) Y-composite graft LITA to LAD, RITA (from LITA) to OM to PDA ( sequential anastomosis)

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  Figure 2 Endoscopic harvesting of radial artery.

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  Figure 3 Composite graft LITA with RITA, or LITA with radial artery.

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  Figure 4 Various incision lines in minimally invasive coronary artery bypass grafting.

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  Figure 5 Reimplantation technique of Left coronary artery to left coronary sinus (26).

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  Figure 6 Unroofing of intramural right coronary artery in the aorta.

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