Coronary Insufficiency: "surgery or angioplasty"

Abstract

Surgery for coronary insufficiency begins with surgery to eliminate the pain of angina pectoris by cutting the sensory nerve pathways to the heart. Subsequently, surgeons attempted to revascularise the myocardium indirectly, by causing adhesions between the heart and various tissues, altering the direction of coronary circulation or creating artificial shunts in the myocardium by implanting the internal mammary artery directly into the left ventricle. But all these techniques proved insufficient, and surgeons turned to direct revascularisation of the coronary arteries. It was in 1968 that the first direct coronary revascularisation by bypass with the long saphenous vein was performed. Under the impetus of the pioneers of cardiac surgery, this type of surgery took off, helped by the development of extracorporeal circulation. Coronary surgery evolved at every level, with the development of microsurgical techniques for anastomoses, the use of arterial grafts, which are more durable than veins, and complete revascularisation. Over time, this surgery will prove to be reliable and reproducible, with excellent results and very low post-operative mortality and infarction rates. Above all, it will improve quality of life and long-term survival. Coronary surgery is still today an indispensable therapeutic tool in the treatment of ischaemic coronary disease.