| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1997;64:1522-1523
© 1997 The Society of Thoracic Surgeons
Department of Cardiothoracic Surgery, University Hospital, S-58185 Linköping, Sweden
To the Editor:
I read with great interest the recent article by Mueller and associates [1]. This is admirable and highly stimulating reading. This excellent review of the history of surgery for ischemic heart disease deals mainly with contributions of American surgeons. Because the largest part of the article is devoted to American surgeons, this review would be in all respects accurate if it was entitled "The history of surgery of ischemic heart disease in America." Otherwise it is difficult to understand why the contributions of two prominent Russian surgeons in the field of coronary revascularization are not described adequately.
Vladimir P. Demikhov, one of the greatest experimental surgeons of all time, is not mentioned at all. However, it was Demikhov who performed the first successful coronary artery bypass grafting (CABG) operation in an experiment. Mueller and associates thoroughly described contributions of many surgeons in nine pages, but paid homage to Professor Vasilii I. Kolesov simply in a few sentences, summing up that his work remained in relative obscurity and when it was reported in 1967 at a cardiology society plenum in Leningrad, the plenum accepted a resolution that the surgical treatment for coronary artery disease was impossible and had no future. However it was Kolesov who performed the first successful clinical CABG using suture technique. Furthermore, between February 25, 1964, and May 9, 1967, the Department of Surgery directed by Kolesov was the only center in the world where CABG was systematically performed [2]. They also applied for clinical CABG a unique vessel-suturing circular apparatus with success. Kolesov authored more than 300 publications [2] including 13 monographs, among them a book, The Surgery of Coronary Arteries of the Heart, published in 1977. A detailed overview of Kolesov's contributions has already been published [2]. Kolesov published his last article on CABG in 1991, a year before his death.
In the early 1950s, Vladimir P. Demikhov performed experiments anastomosing the internal thoracic artery to the left anterior descending artery. The first success was on July 29, 1953. Subsequently, 3 dogs survived more than 2 years and the patency was demonstrated in each. In his monograph, Demikhov devoted several pages to the CABG operation and meticulously described the operative technique [3, 4]. Thus, Demikhov was the first who used the internal thoracic artery for CABG experimentally with success [5]. He investigated the possibility of human application in cadavers. It is obvious that Murray and Demikhov worked independently from each other in the Western and Eastern hemispheres. It is interesting and even surprising that most surgeons are aware of Demikhov's famous dog with two heads, but only a few could recall his contributions to coronary bypass surgery. However, it was the work of Demikhov that enabled Kolesov to undertake further experiments and to perform the first successful sutured internal thoracic artery-to-coronary artery anastomosis. Besides, Demikhov constructed one of the earliest mechanical cardiac substitutes and performed both the first heterotopic heart transplantation into the chest and orthotopic heart transplantation, the first lung transplantation, and the first complete heart and lung replacement in experiments. Unfortunately, he does not have the widespread recognition he earned.
Vasilii I. Kolesov performed the first anastomosis between the left internal thoracic artery and left circumflex artery on February 25, 1964. The patient had no recurrence of angina on 3 years' follow-up. This was reported by Kolesov and Potashov in Russian [6] in 1965, and in English [7] in 1967. Because Donald Effler wrote a comment on this article [7, 8], the Cleveland Clinic team was certainly aware of it before René G. Favaloro performed on May 9, 1967, and reported the first successful CABG operation in America.
I had the opportunity to assist Professor Lev V. Potashov during some operations when I was still a medical student. He always emphasized that it was the work of Demikhov that stimulated them and enabled them to achieve the first success.
On May 2, 1960, Robert Goetz performed a right internal thoracic artery-to-right coronary artery anastomosis using a tantalum ring in a 38-year-old man. Cardiac catheterization on postoperative day 14 showed a patent stented anastomosis. The patient was anticoagulated with warfarin and remained free of angina for a year. He died at Jacoby Hospital, Bronx, NY, on June 23, 1961, of a posterior wall myocardial infarction. Autopsy was not performed, and the long-term patency of the anastomosis was not established [9, 10].
David Sabiston performed an unsuccessful CABG on April 4, 1962. This case was reported in 1974. Garrett, Dennis, and DeBakey performed a successful CABG on November 23, 1964, and did not report this until 1973. Both Sabiston and Garrett bypassed the coronary artery en passant while performing a routine endarterectomy. They did not repeat CABG until the notable contributions of Favaloro and colleagues. René Favaloro performed a successful CABG on May 9, 1967, and was the first in America to report this in 1968.
Thus, Kolesov not only was the first to perform and the first to report successful suture CABG, but also the first to achieve long-term success after CABG, as well as the first to use with long-term success the internal thoracic artery, the graft of choice in modern coronary surgery.
René Favaloro and his colleagues from the Cleveland Clinic are fairly regarded to be the first in America to perform and report successful CABG. It is absolutely true that CABG was revolutionized by the Cleveland Clinic team. In 1968, they performed 171 operations. It was the Cleveland Clinic team that convinced the world, and their contributions cannot be overestimated. However, the popular belief that the world's first successful CABG was performed and reported by the Cleveland Clinic team is not correct.
Vasilii Kolesov died at the age of 87 years on August 2, 1992. Vladimir Demikhov lives in Moscow and celebrated his 80th birthday on July 18, 1996.
The internal thoracic artery is the graft of choice in modern coronary artery surgery. The pioneering work of Demikhov and Kolesov on CABG surgery should be remembered and never omitted from future historical reports. It would also be very useful for all of us, and especially for those who write historical reviews, to realize that to be the first in America does not necessarily mean to be the first in the world. A thorough review of the literature is absolutely necessary to avoid confusing mistakes.
I find it highly advisable, if not mandatory, that the names of Demikhov and Kolesov must be mentioned and their contributions must be adequately acknowledged.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
