Coronary bypass - also called CABG - is the single most common open heart operation performed in most parts of the world !
When a coronary artery is blocked, an alternate route of blood suppy may be created surgically. Using a variety of conduits (leg veins, other arteries) a connection is made between the major blood vessel of the body - the aorta - and the blocked coronary artery, beyond the area of obstruction. In this way, even though nothing is done about the block itself, blood is provided to the heart via the "bypass"....hence the term, coronary bypass surgery.
The first CABG operation was performed in 1962 at Johns Hopkins, Baltimore, by Dr.David C.Sabiston Jr. The leg veins were used to create a pathway between the aorta and diseased coronary arteries. Even today, this is one of the commonly used conduits. Its main drawback is the possibility of plaque-formation in the vein conduit itself over a period of five to ten years, leading to graft occlusion. This has the same consequences as the original disease.
A little known Russian, Kolessof, performed the first CABG operation using another artery as the conduit. He connected an arterial branch in the chest ... called the INTERNAL THORACIC ARTERY (ITA) ... to the blocked coronary artery. {I like the acronym....Right ITA is RITA ...and that's the name of my earliest girl friend ! }
Only later was the significance of using ITAs for grafting understood. After 10 years, 95 percent of these conduits remained free of plaque and repeat obstruction !
Today, this is the CONDUIT OF CHOICE to perform bypass surgery, and significantly improves long term survival after performance of this operation.
When the advantages of using arteries to bypass the coronaries were recognized, many different surgeons used their imagination to expand the choice of arteries to use as conduits.
Today, the possible targets are
Though none has been proven better than ITAs, expectations are that they will be atleast as good, and that the benefits of a bypass operation will then be more long lasting !