Myocardial Revascularization: a Combined Approach.

The surgical treatment of incapacitating angina pectoris is now possible through the use of a combined approach. Direct and indirect myocardial revascularization is combined with resection of ventricular aneurysms or akinetic areas. During the past 20 months, 44 patients have been operated upon. The procedures performed were: 1) single internal mammary artery implants (12 patients); 2) double internal mammary artery implants (18 patients); 3) aortocoronary vein bypass graft (14 patients, 12 to the right coronary and two to the anterior descending arteries). Twelve of these patients had a combined internal mammary artery implantation and three a ventricular aneurysmectomy. Two patients who did not obtain complete relief after indirect myocardial revascularization had one year later a carotid sinus nerve stimulator implanted and they are able to control their angina. Vein grafts have the advantage of relieving angina immediately, and, when possible, are the procedure of choice. The hospital mortality has been 9 percent. The operative techniques are described. The surgical treatment of incapacitating angina pectoris is now possible through the use of a combined approach. Direct and indirect myocardial revascularization is combined with resection of ventricular aneurysms or akinetic areas. During the past 20 months, 44 patients have been operated upon. The procedures performed were: 1) single internal mammary artery implants (12 patients); 2) double internal mammary artery implants (18 patients); 3) aortocoronary vein bypass graft (14 patients, 12 to the right coronary and two to the anterior descending arteries). Twelve of these patients had a combined internal mammary artery implantation and three a ventricular aneurysmectomy. Two patients who did not obtain complete relief after indirect myocardial revascularization had one year later a carotid sinus nerve stimulator implanted and they are able to control their angina. Vein grafts have the advantage of relieving angina immediately, and, when possible, are the procedure of choice. The hospital mortality has been 9 percent. The operative techniques are described.