Optimal myocardial revascularisation by coronary bypass surgery and complementary angioplasty: a study of 100 patients.

One hundred patients underwent early coronary angiography (average 20.5 day s) after coronary bypass surgery between 1994 and 1996. The indications in clinically asymptomatic patients were : study of double mammary grafts, non respect of the preoperative plan (grafts not available, technical difficulties), and/or postoperative ECG changes. 12.1% of intern al mammary grafts and 18.2% of the saphenous vein grafts were considered to be non-fractional : due to occlusion in 3 and 11.9%, due to poor implantat ion site (persistence of a distal stenosis) : 3 and 0.8% respectively. After investigations to detect ischaemia in the region concerned or persist ence of a critical lesion on a non-revascularised main artery, 26 complemen tary angioplasties were performed : 3 on internal mammary grafts, 4 on saph enous vein grafts and 19 on the native vessels. Surgery alone resulted in c omplete revascularisation in 70% and its association with cardiological int erventional techniques increased the value to 85%. The association of coronary bypass surgery and transluminal angioplasty may therefore result in optimal revascularisation. This should reduce the morb idity rate, the number of hospital admissions (recurrent ischaemia and reop eration) and improve survival. However. the exact modalities of this combin ed revascularisation remain to be defined.