Eduardo Augusto Victor RochaI,II
On May 9, 1967, 50 years ago, Dr. René G. Favaloro, an Argentine surgeon operating at the Cleveland Clinic, officially performed the first coronary artery bypass graft surgery (CABG) of the modern era, historically, with many contributions. Alexis Carrel, in 1910, performed the first experience in dogs, using carotid anastomosis with the left coronary artery. However, he discouraged other surgeons to perform this procedure, because he believed the anastomosis should be performed in less than three minutes. In the 1940's and 1950's, other surgeons studied myocardial revascularization, such as Gordon Murray, in Toronto, and Vladimir Demikhov, in Moscow. In the 1960s, although several groups were studying revascularization, Michael DeBakey did not believe in its success and did not think it should be performed in humans.
Robert Goetz was the one who performed and published the first coronary artery bypass graft surgery in humans in 1961, using a tantalum ring[2-6]. Arthur Vineberg published, in 1962, on the implantation of the internal thoracic artery in the myocardium, with other previous studies by this author. Vasilii Kolesov published his Russian experience in 1965 and a series of 12 cases in the Journal of Thoracic Surgery in October 1967. William Longmire published in French in 1966. Other authors such as Donald Kahn, Edward Garrett and David Sabiston did not publish until 1971, 1973 and 1974, respectively.
Favaloro performed the first saphenous vein anastomosis on May 9, 1967, with another 13 cases until October, publishing his results in April 1968. Although the paternity of this procedure is debatable, Favaloro marks the beginning of CABG of the modern era. Several surgeons continued to contribute to the development of this technique, among these some notable Brazilians. Surgery without cardiopulmonary bypass (CPB), conceived by Dr. Enio Buffolo, is one such contribution. Dr. Ricardo Lima was also relevant for performing the revascularization of the posterior branches of the circumflex artery without CPB. The use of dual mammary artery, radial artery, minimally invasive procedures are some of the advances incorporated into classic CABG.
|May 2,1960||Goetz||RITA||Tantalum ring||No angina at 1 year|
|Pt died of AMI 15 years later|
|April 4, 1962||Sabiston||SV||Suture||Pt. died 3 days later|
|(This case first reported in 1974)|
|Feb 25, 1964||Kolesov||LITA||Suture||No angina at 3 years' follow-up|
|Nov 23, 1964||Garrett||SV||Suture||No angina at 7 years' follow-up|
|Dennis||(This case first reported in 1973)|
|March 22, 1967||Kolesov||LITA||Stapling||No angina at 3 years' follow-up|
|May 9, 1967||Favaloro||SV||Suture||Successful|
|Feb 29, 1968||Green||LITA||Suture||Successful|
Source: Konstantinov et al. . AMI = acute myocardial infarction; LITA = left internal thoracic artery; RITA = right internal thoracic artery; SV = saphenous vein.
CABG is probably the most life-saving surgery in the world. Favaloro had a tragic end of life. Frustrated with the financial difficulties faced by his foundation in Argentina, he gave up his life in 2000. A few years ago with the advent of coronary angioplasty and the development of stents, the probable extinction of CABG was decreed. However, trials such as Synthax, Freedom, Nobel, EXCEL among others demonstrate their efficiency with consistent results. As long as no scientific evidence of any better therapy than CABG was found, we will keep on operating and remembering the above-mentioned pioneers. Fifty years later, CABG is more alive than ever showing its strength.
1. Jones DS. CABG at 50 (or 107?) - the complex course of therapeuticinnovation. N Engl J Med. 2017;376(19):1809-11. [MedLine]
2. Kolesov VI, Potashov LV. Operation on the coronary arteries. ExpChir Anaesth. 1965;10:3-8.
3. Favaloro RG. Saphenous vein autograft replacement of severesegmental coronary artery occlusion: operative technique. Ann Thorac Surg.1968;5(4):334-9.
4. Mueller RL, Rosengart TK, Isom OW. The history of surgery forischemic heart disease. Ann Thorac Surg. 1997;63(3):869-78.
5. Konstantinov IE. Robert H. Goetz: the surgeon who performed thefirst successful clinical coronary artery bypass operation. Ann Thorac Surg.2000;69(6):1966-72.
6. Buffolo E, Andrade JC, Succi J, Leão LE, Gallucci C. Directmyocardial revascularization without cardiopulmonary bypass. Thorac CardiovascSurg. 1985;33(1):26-9.
7. Vineberg AM. Surgery of coronary artery disease. Prog CardiovascDis. 1962;4(4):391-418. [MedLine]
8. Kolessov VI. Mammary artery-coronary artery anastomosis as method oftreatment for angina pectoris. J Thorac Cardiovasc Surg.1967;54(4):535-44.
9. Lima RC. Padronização técnica da revascularização do miocárdio daartéria circunflexa e seus ramos sem circulação extracorpórea . São Paulo: Escola Paulista de Medicina, Universidade Federal de SãoPaulo; 1999.