Coronary insufficiency surgery : from symptomatic surgery to microsurgical reconstruction of coronary arteries.

At the beginning of coronary disease surgery, the goal for surgeonswas to reduce the pain of angina pectoris using different surgicaltechniques as cervicothoracic ganglionectomy or section ofpreaortic plexus. In a second step, various indirect surgical methodsof myocardial revascularization were performed such as stimulationof collateral channels by means of adhesions between pericardiumor other tissues and myocardium, reversal of cardiac blood flow andcreation of artificial shunts by implantation of internal mammaryartery in the myocardium. Unfortunately, the success of thesetechniques was less than expected, therefore, direct surgicalreconstruction of coronary arteries became the main challenge forcardiac surgeons. The first successful bypass procedures withautogenous saphenous veins for coronary artery reconstruction wereperformed in early 1968. Thereafter, the number of bypassprocedures increased rapidly helped by continuous improvement ofextracorporeal circulation. In France, Professor Jean-Paul Cacherawas one of the pioneers who gave the surgical technique guidelinesfor a safe and effective coronary artery reconstruction surgery. Themost important changes in surgical techniques like the use ofmicrosurgical techniques for anastomosis, multiple arterial graftsand complete revascularization has led to reduction of postoperativemortality and myocardial infarction, improvement of quality of lifeand increase of survival rate of patients with coronary arterydisease. Coronary artery bypass surgery remains today an effectivetherapeutic tool for coronary artery disease.