Experimental Surgical Treatment of Occlusive Coronary Artery Disease

Abstract

The inexorable increase in the mortality associated with occlusive coronary artery disease is alarming. The gravity of the prognosis of this disease has been emphasized by the disheartening reports of investigators who have followed large series of patients treated conservatively. Parker and his associates (1) reported only a 5-year survival in 3,440 cases with angina pectoris. The picture is even more disheartening in patients having suffered a myocardial infarction. Katz and his co-workers (2) reported 25 per cent of these people to be dead in 2 months, 50 per cent in 1 year, and 75 per cent in 3 years. Several surgical procedures have been utilized in a vigorous attempt to treat occlusive coronary artery disease. None, as yet, have been widely accepted because of the inherent danger entailed by surgery. However, further intensive investigation to find a way to revascularize the ischemic heart seems warranted.In previous work, cardiopericardiopexy produced by a talc granuloma protected the heart against ventricular fibrillation after a major coronary artery was ligated abruptly. This protection was due to a small quantity of blood brought to the heart by an increase in the extracoronary arterial collateral circulation through the pericardium. This fact stimulated a search for an even more vascular structure to which the left ventricular myocardium could be made adherent.This concept led to the development of a pedicled graft from the pectoralis major muscle. Granulomatous adhesions were produced between this pedicled muscle graft and the heart by instilling talcum powder between them. METHODS AND MATERIALSIn the cadaver, a pedicled pectoral muscle graft was brought to the heart. The pectoralis major was transected at its insertion into the humerus and a pedicle was formed of its lower third. Theoretically, the vascularity of this pedicle could be maintained by branches of the internal mammary artery entering it along its sternal attachments ( fig. 1). The fifth costal cartilage was removed, and the left thorax was entered through an anterior inframammary intercostal incision. The pericardium was opened longitudinally, anterior to the at UNIV OF MICHIGAN on July 13, 2015 ang.sagepub.com Downloaded from