Coronary Artery Surgery

1
Coronary Artery Surgery

• Ruchan Akar
• AUTF
• December-2003

2
CABG History

• Alexis Carrel (1872-1944)
• association between angina and coronary stenosis
• canine model of aorto-coronary anastomosis using
  carotid arteries
• awarded Nobel prize

3
Alexis Carrel Triangulating vessels for an
end-to-end anastomosis 1901 First heterotopic
heart transplantation in dog 1907 Nobel Prize,
1912
4
CABG HistoryEarly attempts-

• 1930s-Claude Beck
• epicardial, pericardial abrasion
• omental wrapping
• shunt between the aorta and coronary sinus
• 1951-Arthur Vineberg (Montreal)
• LIMA-to-LV muscle
• (? collateral vessel formation between the
  pedicle and the myocardial sinusoid system)
• Vineberg procedure

5
CABG HistoryEarly attempts-

• 1953- John Gibbon
• cardiopulmonary bypass technology
• 1953- William Mustard (Toronto)
• carotid-to-coronary bypass
• fatal outcome

6
CABG HistoryEarly attempts-

• 1967-Kolessov
• Pavlov Institute-Leningrad
• IMA coronary revascularisation without CPB and
  arteriography via left thoracotomy

7
CABG History

• 1967- Rene Favaloro (Cleveland)
• Long saphenous vein to the coronary artery CABG
  within 6 hrs post-MI
• CABG x 2
• 1968- George E. Green
• LIMA to coronary artery

8
CABG History

• 1986- Loop, Lytle, Cosgrove (Cleveland)
• landmark article (N Engl J Med)
• powerful survival benefit by use of IMA-to-LAD