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Review

Biomechanics of Coronary Artery and Bypass Graft Disease: Potential New Approaches

Department of Cardiothoracic Surgery, Kings College Hospital, London, United Kingdom

^_* Address correspondence to Dr John, Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom (Email: lindsay.john{at}kch.nhs.uk).

The contribution of biomechanical factors to the incidence and distribution of coronary artery and bypass graft disease is underrecognized. This review examined the literature to determine which factors were relevant and the evidence for their importance. It identified two primary biomechanical factors that predispose to disease: (1) low-wall shear stress and (2) high-wall mechanical stress or strain. A range of secondary biomechanical factors have also been identified and include: vessel geometry; vessel movement; vessel wall characteristics and the presence of reflection waves. Potential surgical approaches for minimizing these effects are discussed.