Treatment of Coronary Artery Bypass Graft Failure

The concept of surgical revascularization for coronary artery disease (CAD) originated in the early 20th century. A pioneer in this field is Beck, a surgeon who in 1935 developed an indirect technique of myocardial revascularization by grafting a flap of the pectoralis muscle over the exposed epicardium to create new blood supply. [1] Later, Beck also developed another revascularization technique by anastomosis between the aorta and the coronary sinus. [2] In 1946, the Vineberg procedure was introduced in which the internal mammary artery (IMA) was used to implant directly into the left ventricular and is hence considered the forerunner of coronary artery bypass grafting (CABG). This technique was the first intervention docu‐ mented to increase myocardial perfusion and was successfully performed in over 5,000 patients between 1950 till 1970. [3-5] The major breakthrough in surgery, however, was the invention of the heart-lung machine in 1953, which allowed surgeons to perform open-heart procedures on a non-beating heart and controlled operating field while protecting other vital organs. [6] Still it was not until 1960 when the first successful human coronary artery bypass surgery was performed by Goetz and Rohman, who used the IMA as the donor vessel for anastomosis to the right coronary artery. [7] The bypass graft technique as we know today was developed by Favaloro in 1967. [8] In his physiologic approach in the surgical management of coronary artery disease, Favaloro and his team initially used a saphenous vein autograft to bypass a stenosis of the right coronary artery. Shortly hereafter, Favaloro began to use the saphenous vein as a bypassing conduit. After the saphenous vein bypass procedure was extended to include the left arterial system by Johnson [9], the use of the IMA for bypass grafting was performed by Bailey and Hirose in 1968. [10] Arguably, the first successful IMA – coronary artery anastomosis was already performed 4 years earlier by the Russian surgeon Vasilii Kolesov. [11] Use of the radial artery (RA) as a bypass conduit was introduced by