chapter  1
Historical Considerations
Pages 13

Recently, performing coronary artery surgery on the beating heart received prime attention even though the concept is evidendy not a new one. In 1910, Alexis Carrel (Fig. 1) was the first to propose bypass surgery to correct angina pectoris,1 “In certain cases of angina pectoris, when the mouth of the coronary arteries is calcified, it would be useful to establish a complementary circulation for the lower part of the arteries”. Carrel experimen­ tally put forth effort to develop coronary artery bypass surgery on the beating heart of a dog: “I attempted to perform an indirect anastomosis between the descending aorta and left coronary artery. It was, for many reasons, a difficult operation”. It took him 5 minutes to complete the distal anastomosis but the heart started fibrillating after 3 minutes of ischemia. This was due to cross clamping the entire pedicle of the heart to obtain a bloodless field. Nevertheless, he succeeded by massaging the heart to keep the dog alive for 2 hours. Later, Zoll2 confirmed Carrels premise by showing that in about 50% of fatal coronary artery occlusion cases, the occlusion had occurred in the proximal part of the left coronary artery network, leaving a distal coronary system suitable for imaginative surgical reconstruction. This would contribute to launching the modern era of direct coronary revascularization surgery. However, even before that time, others had already investigated indirect means of supplementing the deficient coro­ nary artery system.