thesis
An Appraisal of Developments in Surgical and Catheter-based Cardiovascular Therapy
- Publication date
- 11 October 2013
- Publisher
- After a few decades of limited experience in treating congenital heart defects, the introduction
of cardiopulmonary bypass in 1954 provided the opportunity to advance cardiac
surgery into an adult patient population. In the 1960s this resulted in the first aortic and
mitral valve procedures to treat patients with valvular stenosis and/or regurgitation. Evolving
from ball-caged valves to stentless porcine bioprosthetic valves, tens of millions of patients
have undergone aortic, mitral, or combined valve replacements with excellent short- and
long-term valve durability and survival, even with the earliest generation of mechanical
valves.
Ischemic heart disease was the leading cause of death in the general population (Figure
1), and the only treatment available at that time -- medical therapy -- fell short to reduce
early mortality. Despite the pioneering work of Arthur M. Vineberg to induce coronary
anastomosis of an internal mammary artery graft by burrowing it in the myocardium, surgical
revascularization did not take off until in the mid-1960s when coronary artery bypass
grafting (CABG) through surgical anastomosis was introduced. Its wide-spread adoption
caused CABG to rapidly evolve as the standard of care for patients suffering from coronary
artery disease.