Twenty Years of Coronary Bypass Surgery

Two decades ago Favaloro first reported successful aortocoronary bypass surgery using autologous saphenous-vein grafts in patients with symptomatic ischemic heart disease.¹ It was quickly demonstrated that in properly selected cases, coronary bypass grafting increased myocardial blood flow and eliminated or alleviated symptoms in a high proportion of cases. Most impressive was the objective documentation of improvement in exercise tolerance and exercise-induced ischemia, something not previously observed with medical therapy. The new procedure was received enthusiastically, and often uncritically, in this country. The number of operations increased rapidly; about 230,000 were undertaken in 1987 in nonfederal hospitals alone (Robertson TL, Cardiac.