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Ann Thorac Surg 1999;67:273-276
© 1999 The Society of Thoracic Surgeons
a Cardiovascular Surgery, Our Lady of Lourdes Medical Center, Camden, New Jersey; and Section of Cardiothoracic Surgery, Episcopal Hospital, Philadelphia, Pennsylvania, USA
Address reprint requests to Dr Olearchyk, 129 Walt Whitman Blvd, Cherry Hill, NJ 08003
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Introduction |
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In the United States during my rotating internship (1967 to 1968), residency in general surgery (1968–1973), and thoracic and cardiovascular surgery (1980 to 1982), my interest in CABG continued. I read Kolesov’s article on this subject in a November 1967 issue of The Journal of Thoracic and Cardiovascular Surgery [1]. By that time, we were all aware of CAGB using vein grafts being performed by Rene G. Favaloro (1923–), beginning on May 9, 1967, at the Cleveland Clinic [2].
While attending a course, Surgery, Part I, at the Albert Einstein College of Medicine, the Yeshiva University, Bronx, New York, on April 28, through November 10, 1974, one of our lecturers was Dr Robert H. Goetz (1910–), who performed a stented anastomosis between the right ITA and the right coronary artery (RCA) on May 2, 1960 [3].
An attention to Kolesov was drawn in the third (1976) edition of the Gibbon’s Surgery of the Chest [4]. Here, credit should be given to Dr Spencer, chairman and professor of the Department of Surgery of the New York University Medical Center in New York, for his honesty, integrity, and vision by including a remark about Kolesov in that book; to quote—"One earlier report describing the use of the internal mammary artery had been published by Kolesov in Russia [1967; should be 1964—ASO], in which the operation was performed on a beating heart, an approach with little clinical application." Subsequent editions, forth through sixth of Surgery of the Chest, contained the same statement by Dr Spencer about Kolesov.
However, there were many other individuals claiming to be the pioneers in CABG. Nevertheless, it appeared to me that coronary revascularization was developed mainly through the work of Goetz, Kolesov, and Favaloro, with the additional contributions of many other researchers.
Then, I decided to write a monograph on CABG. I renewed communication with Dr Goetz (November 16, 1985 through May 13, 1987), obtaining first-hand information on his work on that topic. At the same time, I borrowed Kolesov’s book on Surgery of the Coronary Arteries of the Heart [5] from the National Library of Medicine, Bethesda, and studied it thoroughly in its original Russian language. I also attempted to get additional information from Kolesov himself and to gain access to his other writings. I first wrote to the cultural attache of the Russian Embassy in Washington, DC, and wrote a letter directly to Prof Kolesov, addressing it to the 1st St. Petersburg Medical Institute. The Embassy never gave me an answer, but I eventually received a lively personal letter from Kolesov (March 16, 1987), containing his detailed biographical data, his photograph from 1964, and his remaining writings. From that point on, I was personally in touch with him until his death on August 1, 1992, in St. Petersburg.
So I wrote a monograph on coronary revascularization in Ukrainian and English, with emphasis on Goetz, Kolesov, and Favaloro [6] and a shorter version in Russian [7]. In that monograph, I failed to give credit to Vladimir P. Demikhov [8–11], who performed a sutureless "end-to-end" anastomosis between the left ITA and the proximal left anterior descending (LAD) artery using a stainless steel (Payr’s) tube in dogs on June 29 and July 1, 1953. Subsequently, the English version of that monograph [6] was rewritten and focused on the work of Kolesov [12]. The monograph itself [6] was included by Dr Spencer [13] into the text and the references of the fifth and in subsequent editions of Surgery of the Chest.
After publication of these two articles on CABG [6, 12], Kolesov was awarded the State Prize by the Government of Russia in November 1988.
While on a trip to Russia (July 28 to August 3, 1990) and the Ukraine (August 3 to 17, 1990), we, and our three children, Christina, Roman, and Adrian, were invited to be guests at the Kolesov’s apartment in St. Petersburg. On July 30, we took a Mercedes taxi from the Pribaltiyskaya Hotel, ul. Korablestroiteley 14, St. Petersburg, to Prof Kolesov’s apartment at Kirovskii pr. 25, kv. 3, and we arrived at 6 PM (18.00; Fig 1). Prof Kolesov and his wife lived at their dacha during the summer to avoid the stifling heat of the city.
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We were greeted by the father and son, who collaborated with him on improvements in and on the clinical application of an "end-to-end" vessel suturing circular apparatus (VCA "U.S. patent on Kolesov et al #4,350,160, September 21, 1982," regarding an "instrument for establishing vascular anastomosis; application No. 136736, April 2, 1980").
After 3 years of extensive correspondence, we finally had the opportunity of meeting this great military and cardiac surgeon. Both father and son greeted us warmly. Prof Kolesov was of short stature and slim, almost frail. He gazed at each of us through thick bifocals, which could not hide his keen and kind blue eyes.
The initial focus of conversation, in Russian, was about Prof Kolesov’s work, filling in what the numerous letters could not have done completely. He explained his removable two halves of a cannula (Kolesov’s split cannula), which was used to create a quick anastomosis between the ITA and a coronary in dogs without interruption of blood flow [1]. He and his son demonstrated the technique of an end-to-end mechanical anastomosis between the ITA and coronary using the VCA-4 model. He underscored the need of measuring the blood flow, using in the past the electromagnetic manometry by waveform [1], and at present, Doppler ultrasonography, distally to an anastomosis, to make sure that it is patent.
Later numerous questions were answered about our personal life, my professional and clinical research work. Prof Kolesov spoke some English, and his son spoke quite fluently. Occasionally, my wife and the children, who did not speak Russian, were asked questions in English about their interests and activities.
During that visit I gave Kolesov the textbook Surgery of the Chest fifth edition, edited by DC Sabiston, Jr and FC Spencer. Kolesov gave me his book entitled Surgery of the Coronary Arteries of the Heart with a personal dedication to me in Russian— "To Andrei Semenovich Olearchyk with respect and gratitute. V. Kolesov. July 30, 1990. St. Petersburg." He and his son also gave me the VCA-4 model that they had just demonstrated, with the suggestion that I modify it into an end-to-side model. But I informed them that, as I was busy in a difficult competitive private practice, I did not have the proper climate and the resources to conduct such extensive research.
At one point in the evening. Evgenii showed us the building of the Department of Surgery (Fig 2) where his father worked, which was within walking distance from the apartment.
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He expressed his opinion that too many CABG are being done per population and too many grafts per patients, and that in a stable patient, easily accessible coronary arteries, like the LAD artery and its diagonal branch and RCA, should be grafted on a beating heart.
Kolesov asked us questions about various aspects of life in the United States. His sharp mind pursued our answers with keen insights. Then he expressed his gratitute to renowned American cardiac surgeons, specifically to Brian Blades, and Donald B. Effler for publishing his article in 1967 [1], to Spencer for including him in the Surgery of the Chest [4, 13] to Dwight C. McGoon and John W. Kirklin for accepting the article about him in 1988 [12]. Both Kolesovs were highly cultured, soft-spoken, humble, with extensive knowledge of world culture, specifically history, literature, and music.
After our visit, Evgenii accompanied us back to our hotel via the incredibly swift St. Petersburg subway (metro), and a 20-minute walk at 11 PM in St. Petersburg’s white night.
At Prof Kolesov’s request, I edited his and his son’s manuscript on the long-term results of ITA grafting [14].
On March 13, 1994, I donated my original correspondence with Kolesov and his son (1987–1993), and correspondence relating to Kolesov with Drs McGoon, Kirklin, and others, to the V. I. Vernadsky Central Scientific Library of the National Academy of Science of Ukraine in Kyiv.
My final obligation toward the now decreased Kolesov was to correct the errors about the 1967 versus the 1964 dates, of the first sutured anastomosis between the left ITA and coronary artery, that occurred in Surgery of the Chest, edited by DC Sabiston, Jr and FC Spencer, third through sixth editions. I wrote about this to Dr Spencer on November 21, 1995. I also asked Dr Spencer to return to the original name of the city and the 1st Medical Institute (St. Petersburg), where Kolesov lived and worked. Dr Spencer kindly assured me in his reply of December 5, 1995, that the error will be corrected in the next edition.
My writings on the history of CABG had three goals. First, to give due credit to the appropriate individuals, while not neglecting the contributions of others. This goal was fulfilled [6, 7, 12]. The second goal was to resurrect the interest in performing CABG on a beating heart by bringing back from the depth of history the experience of Goetz and Kolesov. That goal is being tested now in the form of minimally invasive direct CABG [15–17]. The third goal was to stimulate interest in mechanical ITA to coronary artery suturing, initiated by the Kolesovs in the form of end-to-end anastomosis, and therefore, to improve the existing VCA-4 model or to develop new devices suitable for an end-to-side suturing, which could greatly facilitate CABG with and without cardiopulmonary bypass. Those devices are currently being tested [18].
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