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Ann Thorac Surg 1994;57:1354-1364
© 1994 The Society of Thoracic Surgeons

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Articles

The Vineberg procedure: The immediate forerunner of coronary artery bypass grafting

Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

^_* Address reprint requests to Dr Shrager, Department of Surgery, Hospital of the University of Pennsylvania, 4 Silverstein, 3400 Spruce St. Philadelphia, PA 19104.

Promulgated by the Canadian surgeon Arthur Vineberg, internat mammary artery implantation received fairly widespread clinical application during the 1960s, only to be abandoned upon the introduction of coronary artery bypass grafting toward the end of that decade. By 1978, Hurst and Logue's The Heart (4th ed. New York: McGraw-Hill, page 1291) mentioned the procedure only to relate that "indirect myocardial rcvascularization using the internal thoracic artery is now seldom used." Between the introduction of the operation in 1945 and the mid-1960s, a remarkably hard-fought debate raged over the value of internal mammary artery implantation. Despite the fact that coronary arteriography ultimately demonstrated the viability of Vineberg's concept, for a variety of reasons the operation could not compete with coronary artery bypass grafting, and therefore rapidly fell into disuse. The central role the Vineberg procedure has played in the evolution of coronary revascularization surgery highlights the importance of reviewing the history of its development, application, and eventual abandonment. The Vineberg procedure was, after all, the first intervention documented to increase myocardial perfusion. Recent reports of long-term graft patency and clear patient benefit with internal mammary artery implants reinforce the belief that Vineberg should be given more credit for his work than he has generally received, and that internal mammary artery implantation should not be relegated to the status of a historical curiosity.

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