Cardiac surgical therapy of atherosclerosis and angina

Abstract

Although there is almost universal agreement that coronary artery bypass grafting has been a major advance for therapy of the patient moderately or severely symptomatic with angina pectoris, there is less agreement and often controversy over its use in certain groups of patients with coronary artery disease. For example, it is unclear whether to advise revascularization surgery for the patient minimally symptomatic with angina pectoris; for the asymptomatic patient with a positive exercise test and coronary artery disease; for the asymptomatic patient with calcification in the coronary arteries seen at fluoroscopy, and subsequently proven coronary disease [1]; for the patient with proven coronary artery spasm, mild to moderate, and fixed coronary artery restrictive disease; for the patient symptomatic with angina but with single-vessel coronary disease; and for the patient with recurrent angina despite one or two prior coronary bypass operations. A dilemma which is as yet unanswered is what role will calcium-blocking agents play in decisions for surgery in the presence of known coronary artery disease. Yet another and different focus of concern is the economic impact that coronary artery bypass surgery would have if advised in all patients with coronary artery disease [2, 3]. Unfortunately, the tabulation of these areas of uncertainty does not imply that we shall provide solutions to them in this chapter. It does signify that coronary artery bypass surgery is a useful form of therapy but should not be advised routinely as we face therapeutic options at any given point in the life history of a patient with coronary artery disease.