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HEART SURGERY: CORONARY ARTERY BYPASSES

New Techniques

Two developments led to a revolution in the field of cardiovascular surgery during the middle of the decade. The first was cardiac catheterization to penetrate interior walls of the coronary arteries. This technique was pioneered by Dr. F. Mason Sones of the Cleveland Clinic in 1959. The second new method was revascularization, developed by Dr. Arthur M. Vineberg in Montreal and refined at the Cleveland Clinic by Vineberg and Dr. Donald Effer. Vineberg used a shunt to direct the flow of blood from the nonessential left internal mammary artery to the heart, bypassing diseased arteries. By the end of 1966 he had performed the surgery eighty-seven times with only three deaths due to the operation. Forty of his patients had returned to work.

A Multiple-Graft Procedure

The mammary-artery graft worked well but was useful only if one coronary artery needed repair. The heart is served by three main artery branches, and frequently more than one artery or artery branch required a shunt to provide the necessary supply of blood to the heart. The procedure that eventually allowed multiple grafts was the coronary-artery bypass graft (CABG), in which veins from patients' legs were used to repair the coronary arteries. Vineberg, Effer, Dr. C. Walton Lilledi at the University of Minnesota, and DeBakey in Houston all worked on similar procedures at about the same time, but DeBakey is usually said to have been the first to develop CABG, which became a routine procedure in subsequent decades.