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Myocardial revascularization without cardiopulmonary bypass: historical background and thirty-year experience.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Buffolo, Enio Lima, Ricardo De Salerno, Tomas Antonio |
| Copyright Year | 2011 |
| Abstract | Myocardial revascularization without cardiopulmonary bypass (CPB) was introduced into surgical practice years after conventional coronary artery bypass surgery utilizing CPB. The initial series of consecutive patients revascularized without CPB were reported by a few groups, showing the possibility of achieving similar results via a less invasive approach. The technique, however, did not gain immediate widespread acceptance due to difficulties in performing coronary artery anastomoses on a beating heart. Two decades later, controversy still remains regarding case selection, advantages and pitfalls of the technique. The historical background of the development of off pump coronary surgery is herein presented, as well as points of view regarding training, longterm results, and applicability. Historically, among several indirect myocardial revascularization procedures, only the Vineberg operation developed at McGill University in Montreal, Canada by Dr. Arthur Vineberg, showed promising results. At that time he performed the procedure without knowledge of coronary artery anatomy [1]. Direct myocardial revascularization was later made possible with the introduction of coronary angiography by Mason Jones at the Cleveland Clinic in the early sixties [2]. Rene Favaloro, in the same Institution, pioneered direct coronary artery revascularization with the use of reverse saphenous vein, utilizing CPB and cardiac arrest. His initial reports focused on selection of patients and technical challenges with the operation. It is to be noted that Garret et al, in November 1964, performed a coronary bypass grafting with a segment of saphenous vein, instead of endarterectomy, without knowledge of the coronary anatomy, thereby antedating Rene Favaloro. A successful seven-year follow up of this patient was later published [4]. The familiarity of surgeons with CPB circuits and the development of myocardial protective strategies led surgeons to perform myocardial revascularization procedures on CPB, despite the fact that the coronary arteries are located on the surface of the heart. Also, the operation was performed on an arrested, rather than beating, heart. The idea of constructing a coronary artery bypass anastomosis on a beating heart was conceived, and performed long before saphenous vein grafting under CPB and cardiac arrest. In 1953, Demikhov [5], in Russia, and Murray et al. [6], in Canada, simultaneously performed left internal mammary artery anastomoses to the left anterior descending coronary artery in a beating heart. Goetz et al. [7], in 1961, continued experimental direct myocardial revascularization with the mammary artery and mechanical suture with tantalum ring. Kolesov & Potashov [8,9] reported in the Russian literature in 1965, and later in the United States in 1967, the first clinical experience with mammary artery coronary bypass to the left anterior descending coronary artery in a beating heart via left thoracotomy. Mechanical suture was utilized in a few cases. All these operations were performed without the benefit of angiography, which had not been developed at that time. Years later, Trapp & Bisarya [10] in Canada and, in the same year, Ankeny [11] in Western Reserve – Cleveland, independently reported acceptable results using this technique. Technical difficulties and the fear that occlusion of a coronary artery could lead to ischemia and myocardial infarction, hampered the acceptance of this procedure. Complex perfusion devices were considered necessary, as illustrated in a paper published by Trapp & Bisarya, outlining some of the obstacles for construction of the distal coronary artery anastomoses under these conditions [10]. Years later, Buffolo et al. [12] and independently, Benetti [13] reported consecutive series of patients undergoing saphenous vein or mammary artery bypass grafting to left |
| Starting Page | III |
| Ending Page | VII |
| Page Count | 5 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://www.scielo.br/pdf/rbccv/v26n3/v26n3a02.pdf |
| PubMed reference number | 22086599v1 |
| Volume Number | 26 |
| Issue Number | 3 |
| Journal | Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Anatomic structures Anterior descending branch of left coronary artery Cardiac Arrest Cardiopulmonary Bypass Coronary Artery Bypass Surgery Coronary angiography Endarterectomy HL7PublishingSubSection |
| Content Type | Text |
| Resource Type | Article |
