While the timeline has been relatively abbreviated, there has been significant evolution in the field of cardiac surgery. These changes have been driven by a combination of operative innovation, changing patient demographics, and novel critical care resources, all of which have allowed today's surgeons to treat a myriad of conditions among increasingly higher risk patient cohorts. At the same time, this has forced providers to expand their clinical skill sets, embrace multidisciplinary collaboration, enhance postoperative care, and intensify the rigor by which outcomes and quality are being measured. In spite of this increasing complexity, however, mortality in cardiac surgery continues to improve. In this chapter, we highlight key historical events and describe an unprecedented trajectory and evolution in care practices that have helped shape modern cardiac surgery. We also make an appeal for additional research efforts which are needed to ensure sustained and innovative growth.
TopEvolving Care For The Patient With Coronary Artery Disease
The foundations of cardiac surgery date back to the late 1800s when the treatment of angina pectoris became a focal point for operative innovation. While ligation of pain pathways and creative approaches to sympathectomy did seem to improve the symptoms of ischemia (Harken, Black, Dickson, & Wilson, 1955), these interventions did little to attenuate the other deleterious effects of progressive epicardial coronary disease (i.e. myocardial infarction, arrhythmia, and heart failure). As a result, the development of novel methods for improving collateral blood flow to the ischemic myocardium became strong motivation for evolving surgical care. In 1903, for instance, Thorel (1903) proposed a mechanism by which pericardial adhesions could improve myocardial perfusion. Through the use of either irritant therapies or mechanical intervention, other like-minded surgeons soon created and shared their unique methods for augmenting blood flow using a pericardial substrate (Moritz, Hudson, & Orgain, 1932). Shortly thereafter, muscle (Beck, 1935), omentum (O’Shaughnessy, 1936), and even intestinal grafts were employed to treat ischemia through collateralization (Key, Kergin, Martineau, & Leckey, 1954).
It wasn’t until the mid-1960s, however, that vascular conduits were finally used as a means for mechanically bypassing obstructive coronary lesions. Vasilii Kolesov (Olearchyk, Vasilii, & Kolesov, 1988) was believed to have been the first to perform anastomosis of the internal mammary artery to the left anterior descending (LAD) vessel. Following closely on the heels of Kolesov’s report, others described the use of saphenous vein grafts for surgical revascularization (Garrett, Dennies, & DeBakey, 1973). By many, however, Rene Favaloro is considered the “father of modern bypass surgery” – while not the first to describe this operation in detail, he was one of the first to perform the coronary artery bypass graft (CABG) procedure with consistent rigor, and one of the first to share and publish his reproducible outcomes (Favaloro, 1969).