HISTORICAL REVIEW

Atherosclerotic coronary artery disease is the main cause of death amo ng the adult population in developed countries. Therefore, its surgica l treatment has special importance and relevance. Surgery for coronary artery disease has evolved spectacularly since its inception in clini cal practice. Indirect revascularization procedures had their foundati ons in medical concepts with more than a doubtful scientific basis. Cl inical results used to be poor and unpredictable and the older techniq ues were slowly abandoned. Many newer techniques appeared in an attemp t to improve the results. The implantation of the left internal mammar y artery directly in the left ventricular myocardium through a tunnel deeply drilled within the muscle mass was later developed. It was init ially thought that this method could supply an important amount of blo od to the diseased myocardium. Clinical results were encouraging and p ostoperative mammary angiography showed definite connections with the coronary arterial tree; however this only happened in a small number o f patients. Direct myocardial revascularization was attempted in order to restore the oxygenated blood supply to the myocardium. Patches, en darterectomies and bypass grafts were constructed and clinical results showed them to be safe and their outcomes could also be objectively a ssessed.