[Optimizing therapeutic success in aortocoronary bypass operations]

Left ventricular function improves after aortocoronary bypass operation in 80% of preoperative postextrasystolic reversible asynergic segments, but this usually does not occur in preoperative postextrasystolic irreversible segments. Improvement is often seen even without revascularisation of the corresponding vessel, when a bypass to another stenosed vessel enables enhanced collateral flow. Therefore, it is recommended to graft as many stenosed vessels as possible, even those corresponding to postextrasystolic irreversible segments, to provide beneficial effects in other segments. To achieve a real complete revascularisation, vessels with about 50% stenosis or total occlusion should also be bypassed. For multiple stenosed vessels sequential graft technique is recommended. In lesions not suitable for grafting an endarterectomy should be performed however the risk of intraoperative infarction should be considered. Platelet inhibition after bypass operation results in a significant increase of patency rate. Low dose acetylsalicylic acid is the treatment of choice and should be started very early postoperatively.