Our Surgical Heritage
The History of Surgery for Ischemic Heart Disease

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Abstract

Myocardial revascularization had its beginnings in the early 1900s with extracardiac operations, such as sympathetic denervation and thyroid ablation. From there it evolved through neovascularization via pericardial poudrage and cardiopexy in the 1930s to 1950s, to mammary artery myocardial implantation in the 1940s and endarterectomy in the 1950s, to saphenous vein– and mammary artery–coronary artery bypass grafting in the 1960s. The history of the surgical treatment of myocardial ischemia is presented here in chronologic sequence to highlight the prescient thinking and the persistence of efforts, as well as the false starts and the rediscovery of old ideas, that have marked the development of this treatment.

Section snippets

The First Era (1880–1934): Basic Observations and Extracardiac Operations for Angina

The idea for coronary artery surgical procedures was planted in 1880, when Langer [4]first described the existence of extensive, minute vascular communications between the normal coronary circulation and the vascular supply of surrounding extracardiac structures such as the diaphragm, bronchi, and the pericardium. Surgeons subsequently seized upon this and other evidence that the coronary circulation could in fact communicate with other circulations and worked in the hope that these

The Second Era (1935–1953): Indirect Revascularization Operations by Beck, Vineberg, and Murray

In the second era the surgical treatment of coronary artery disease moved from observations and indirect operations to direct operations on the heart, which was assaulted in countless ways in an effort to induce neovascularization and improve collateral circulation to the myocardium. The heart was abraded, irritated, scarred, wrapped, implanted, denervated, and perforated with acupuncture needles; the cardiac venous drainage was ligated and arterialized.

This era of indirect methods of

The Third Era (1954–1966): Early Forms of Direct Coronary Artery Surgical Procedures

In 1954 Murray reported the successful experimental bypass grafting, performed on beating dog hearts, of systemic arteries, including carotid, axillary, and internal mammary arteries, directly onto coronary arteries (Fig. 4). Building on Carrel’s pioneering efforts using arterial conduits for coronary bypass, Murray was the first to employ the internal mammary artery. Although Battezzati and colleagues rekindled interest in mammary artery ligation in 1955, the following year several workers

The Fourth Era (1967–Present): Coronary Artery Bypass Grafting Comes of Age

Several major milestones occurred in 1967, beginning on May 9, 1967, when the Argentina-born Rene Favaloro, a young thoracic surgeon who had recently completed his fellowship, initiated the clinical use of saphenous vein bypass graft techniques at The Cleveland Clinic. Impressed by the similar use of saphenous vein autografts in peripheral and renal arterial bypass procedures, Favaloro, Effler, Proudfit, and their colleagues had been prompted to switch from using Effler’s endarterotomy–patch

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    Copyright © 1997 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.