How was coronary artery bypass grafting (CABG) developed as a treatment for coronary artery disease (CAD)?

Updated: Dec 04, 2019
  • Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

Alexis Carrel received the Nobel prize in physiology and medicine for his work in 1912. His understanding of the association between angina pectoris and coronary artery stenosis allowed him to anastomose a carotid artery segment to the left coronary artery from the descending thoracic aorta in canine model. [14]

In the late 1940s, the famous Canadian surgeon Arthur Vineberg implanted the left internal thoracic (mammary) artery, directly into the myocardium of the anterior left ventricle in patients with severe angina pectoralis. [15, 16, 17] Surprisingly, this procedure produced significant symptomatic relief in a few patients. [18]

In 1962, Sabiston, at Duke University, performed the first planned saphenous vein bypass operation for coronary revascularization. [19]  In 1964, Kolessov used the left internal thoracic (mammary) artery to bypass the left anterior descending artery without cardiopulmonary bypass, [20] and, in 1973, Carpentier introduced the use of radial artery grafts as conduits for CABG. [21, 22]

In the 1970s and early 1980s, CABG flourished as the sole therapy for CAD.  With the advent, introduction, and widespread adoption of percutaneous coronary artery stenting in the 1980s and 1990s there was a decline in the number of CABG operations performed. However, several multicenter studies comparing CABG with current stent therapy have clearly demonstrated the superiority of CABG, especially when certain patient characteristics such as diabetes, multivessel CAD and ischemic cardiomyopathy are taken into account.


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