Direct and Indirect Coronary Surgery

Early in 1962, the Cleveland Clinic team attempted to perform true endarterectomies. Nevertheless, the mortality rate was extremely high, due mainly to dissection of the distal portion of the coronary circulation or occlusion of important side branches, and the procedure was abandoned. The next method used was the pericardial patch-graft reconstruction. A longitudinal incision was made at the site of the obstruction precisely located by reviewing carefully the preoperative coronary cineangiography. A patch was sewn with fine 6-0 silk, generally with running sutures at both sides and interrupted sutures at the proximal and distal ends. There was low operative mortality