[Preliminary report on coronary revascularization in 15 patients under 35 years of age]

Between 1975 and 1979 15 patients under 35 underwent aorto-coronary bypass-grafting. The youngest was 24 years old. Out of 1188 revascularized patients over the same period, only 1.26% of surgically treated patients with coronary artery disease were under 35, whereas 4.79% were under 40. The main risk factors were smoking, overweight and hyperlipidemia, and every patient had several risk factors. 12 of 15 patients had preoperative infarctions. 3 patients had single vessel disease, 3 had double vessel disease and 9 had triple vessel disease, the latter two groups with massive and diffuse disease down to the peripheral vessels. By the usual criteria some of them had been refused for revascularization and only their youth and disabling angina without hope of improvement through medical therapy prompted us to operate on them. At operation 2.73 grafts per patient were performed, three of which were internal mammary artery anastomosis. Operative mortality was nil. Only one patient had a perioperative myocardial infarction, without complications or hemodynamic impairment. Another patient sustained a re-infarction four months postoperatively. However, this patient did not reduce any of his risk factors. At postoperative angiography 32 out of 40 grafts performed, i.e. 2.13 grafts per patient, were patent. In 9 patients all grafts were patent, in 4 over 51% of the grafts performed were patent, in 1 two out of four were patent and one single-bypass was subtotally occluded. The angina-free working tolerance increased postoperatively by 70 Watts, i.e, by 100%. These preliminary results with 15 patients under age 35 show that satisfactory medical and professional rehabilitation can be achieved with coronary artery surgery. All but one returned to work as they would otherwise have been unable to do because of disabling angina under maximal medical therapy.