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Ann Thorac Surg 2003;76:338-339
© 2003 The Society of Thoracic Surgeons
a Hôpital Sud 80054, Amiens Cédex 1, France
e-mail: poulain.henri{at}chu-amiens.fr
To the Editor:
I read with interest the editorial by Dr Suma [1], and was surprised to see that the inventors of the "gold standard" arterial conduit bridge were not even quoted. In 1967, Vasili Kolesov [2] described an anastomosis between the internal mammary artery (IMA) and the left anterior descending artery. The operation was carried out without extracorporeal bypass, and no coronarography was done previously. Kolesov was surely a great pioneer, but for many reasons, which are only now understandable, coronary surgery did not benefit from his genius and there was no major breakthrough at that time from the Soviet Union. In fact, beating-heart surgery through thoracotomy, the Kolesov procedure, only reappeared 15 years later.
Conversely, regular coronary surgery using the IMA as a conduit and carried out under total cardiopulmonary bypass (nowadays, the most frequent major procedure realized throughout the world on a daily basis) is the very procedure invented by G. E. Green. In February 1968 [3], he was the first to use this artery to successfully bypass a stenosed left anterior descending artery under total bypass after preoperative coronary angiography. Aware of the poor long-term results of venous bypasses in peripheral arterial surgery, and having experience in handling vessels of 1 mm in diameter, Green had worked on the idea of this operation for at least 5 years before being in a position to attempt it and to make it a safe, reliable, and reproducible procedure.
Technical difficulties were reduced by cardiac standstill, full ventricular decompression on total cardiopulmonary bypass, and use of high optical magnification (x8). Although immediately adopted by some surgeons throughout the world, this technique remained marginal for a few years, especially in the nation where most coronary surgery operations was done. Nobody is a prophet in his own country!
Indifferent to the saphenous vogue of the 1970s, but influenced by his own good results, Green started to use bilateral mammaries as early as 1972. Consequently, he wrote several papers with the view of increasing use of the IMA. It must be conceded that the Cleveland Clinic was one of the first big teams to switch from the saphenous vein to use of the mammary artery, as for decades, they had been carrying out many Vineberg procedures. The very large series published by the Cleveland Clinic team in 1986 helped popularize use of the IMA, as emphasized by Suma in his editorial, but at that time, Green was already routinely using both mammary arteries with sequential anastomosis. Three years earlier, he had repeatedly urged his colleagues to develop wider use of the IMA [4].
For more than 30 years, most of the procedures involving the IMA have been carried out using the technique first described by Green. This needed to be clarified to bridge a gap... over troubled water!
References
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