History of Coronary Bypass Surgery

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Coronary artery bypass surgery, also coronary artery bypass graft (CABG, pronounced "cabbage") surgery, and colloquially heart bypass orbypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage ofcardiopulmonary bypass; techniques are available to perform CABG on a beating heart, so-called "off-pump" surgery. Contents  [hide]  * 1 History * 2 Terminology * 2.1 Number of bypasses * 3 Indications for CABG * 4 Prognosis * 5 Controversy * 6 Procedure (simplified) * 7 Minimally invasive CABG * 8 Conduits used for bypass * 8.1 Graft patency * 9 Sternal precautions * 10 Complications * 10.1 CABG associated * 10.2 General cardiac surgery * 10.3 General surgical * 11 Follow up * 12 See also * 13 References * 14 External links| -------------------------------------------------

The first coronary artery bypass surgery was performed in the United States on May 2, 1960, at the Albert Einstein College of Medicine-Bronx Municipal Hospital Center by a team led by Dr. Robert Goetz and the thoracic surgeon, Dr. Michael Rohman with the assistance of Dr. Jordan Haller and Dr. Ronald Dee.[1][2] In this technique the vessels are held together with circumferential ligatures over an inserted metal ring. The internal mammary artery was used as the donor vessel and was anastomosed to the right coronary artery. The actual anastomosis with the Rosenbach ring took fifteen seconds and did not require cardiopulmonary bypass. The disadvantage of using the internal mammary artery was that, at autopsy nine months later, the anastomosis was open, but an atheromatous plaque had occluded the origin of the internal mammary that was used for the bypass.[citation needed][verification needed] Russian cardiac surgeon, Dr. Vasilii Kolesov, performed arguably the first successful internal mammary artery–coronary artery anastomosis in 1964.[3][4] However, Goetz's has been cited by others, including Kolesov,[5] as the first successful human coronary artery bypass.[6][7][8][9][10][11][12] Goetz's case has frequently been overlooked. Confusion has persisted for over 40 years and seems to be due to the absence of a full report and to misunderstanding about the type of anastomosis that was created. The anastomosis was intima-to-intima, with the vessels held together with circumferential ligatures over a specially designed metal ring. Kolesov did the first successful coronary bypass using a standard suture technique in 1964, and over the next five years he performed 33 sutured and mechanically stapled anastomoses in St. Petersburg, Russia.[13][14] Dr. René Favaloro, an Argentine surgeon, achieved a physiologic approach in the surgical management of coronary artery disease—the bypass grafting procedure—at the Cleveland Clinic in May 1967.[4][15] His new technique used a saphenous vein autograft to replace a stenotic segment of the right coronary artery. Later, he successfully used the saphenous vein as a bypassing channel, which has become the typical bypass graft technique we know today; in the U.S., this vessel is typically harvested endoscopically, using a technique known as endoscopic vessel harvesting(EVH). Soon Dr. Dudley Johnson extended the bypass to include left coronary arterial systems.[4] In 1968, Doctors Charles Bailey, Teruo Hirose and George Green used the internal mammary artery instead of the saphenous vein for the grafting.[4] -------------------------------------------------


Three coronary artery bypass grafts, a LIMA to LAD and two saphenous vein grafts – one to the right coronary artery (RCA)...
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