Coronary Endarterotomy with Patch-Graft Reconstruction

Vascular corrosion casting of human heart

“…6 In a study revealed on the basis of 6000 selective arteriogram, the right coronary predominance was present in 60% of persons. 7 Most common form of coronary circulation was found to be the right dominant. 8 Ahmed et al found 73.4% of anastomoses, most commonly associated to right dominance.…”

Endarterectomy and Surgical Angioplasty Without Cardiopulmonary Bypass

“…Removal of segmental disease from the right coronary artery with patch‐graft reconstruction improves collateral circulation to the left side of the heart 3 . Off‐pump endarterectomy combined with bypass grafting is now a widely performed procedure with good long‐term outcomes 4 .…”

History of vein grafting

“…The first efforts at reconstruction by direct suture used patch grafts, first obtained from saphenous vein and later from the epicardium, to close a coronary endarterotomy over the site of the lesion. 21 These authors recognized the possibilities of using magnification to better visualize the vascular repair. However, they encountered technical difficulties in their experimental efforts to perform bypass grafts:…”

“…Even reconstruction of small vessels with the aid of a microscope invariably led to late stricture; success was obtained only with patch-graft reconstruction. 21 In 1968 one of these authors from the Cleveland Clinic, Favaloro, published a description for surgical bypass of the coronary lesion using an autogenous vein graft from the aorta to a distal point on the coronary artery. 22 The success rate in the first 55 patients was dramatic; only two hospital deaths were encountered.…”