An Appraisal of Developments in Surgical and Catheter-based Cardiovascular Therapy

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.