ABSTRACT
Evolution in techniques for the correction of coronary artery disease coupled with an improved understanding of basic pathophysiologic mechanisms (in grafts and in native coronary arteries) have led to an improvement in the quality of life and survival for patients undergoing surgical revascularization. The internal thoracic artery (ITA) was used clinically by Vineberg as early as 1946 when he implanted it into an intramyocardial tunnel in the left ventricle. Green and colleagues reported the early experience with direct anastomosis of the ITA in 1966 but it took 30 years until Loop showed superior outcomes with ITA use. Subsequent reports by Lytle confirmed that bilateral ITA grafting is associated with survival benefit of 10% at 10 years.
