Myocardial Revascularization

Abstract

THE SURGICAL treatment of ischemic heart disease is not new. Omentopexy, epicardiectomy, poudrage, and various types of neurectomy or sympathectomy were introduced prior to World War II. Perhaps the most exotic procedure introduced in this early era was the internal mammary implant procedure proposed by Vineberg¹of Montreal. Generally speaking, these surgical procedures intended for the coronary patient evoked limited enthusiasm from the profession at large. This initial era of revascularization surgery failed primarily because the diagnostic procedures of the time were inadequate, both for (1) proper case selection and (2) worthwhile assessment of the patient who did survive a given surgical procedure. The current era of revascularization surgery follows the introduction of selective coronary arteriography. In 1958, Sones and Shirey²demonstrated the feasibility of selective coronary arteriography by combining the image intensifier and catheter injection of both the right and the left coronary ostia. With refinement, Sones'