Surgical Treatment of Variant

Aortocoronary bypass surgery, widely accepted in the treatment of patients with coronary artery disease, is controversial in the management of variant angina. Persistence of attacks, occlusion of the graft or postoperative infarction have been described and could be explained by a persistent spasm frequently observed in variant angina that might occlude the distal part of the grafted vessel. It has been suggested that plexectomy might be added to the aortocoronary graft procedure in order to prevent the spasm. Our study includes 35 patients with variant angina who had surgery. They were divided into two groups. Group 1 (n = 13) had aortocoronary bypass alone; the patients in group 2 had plexectomy in addition to the myocardial revascularization. The average follow-up period was 37 months in group 1 and 20 months in group 2. The results were assessed by clinical study, stress testing, control of patency of the grafts and provocative test with an ergot alkaloid (methergine). Despite the difficulties of evaluating the effects of the various treatments in these patients with a wide spontaneous variability of symptoms, these data suggest that a complete plexectomy associated with aortocoronary bypass gives better results (86%) than bypass alone (61%) in variant angina. The recurrence rate of attacks was lower (5%) when plexectomy was associated with bypass than with bypass alone (18%).