Memento for René Favaloro.

Rene G. Favaloro moved to the Cleveland Clinic in 1962 and with him came a wind of change that was to reshape cardiac surgery forever. With his cherished colleagues, Effler, Sones, Proudfit, Groves, Sheldon, and countless others, he contributed to the double internal mammary artery-myocardial implantation by the Vineberg method, and, subsequently, in May 1967, he reconstructed the right coronary artery by saphenous vein graft interposition. These milestones set the stage for aortocoronary saphenous vein bypass grafting in October 1967. Several other breakthroughs rapidly followed: the application of the bypass technique to the left coronary artery, the combination of coronary artery bypass grafting with left ventricular reconstruction and valve repair or replacement, and finally, by December 1967, a double bypass to the right coronary artery and the anterior descending branch of the left coronary artery. Emergency coronary artery bypass grafting in patients with acute myocardial infarction soon became Favaloro's next focus. In 1970, he was influenced by the work of George Green in New York City and began using the direct mammary-coronary anastomosis with a few modifications, which popularized it. In June 1971, Favaloro decided to leave the Cleveland Clinic and return to Argentina, where he created a medical center, a teaching unit, a research department, and, finally, an Institute of Cardiology and Cardiovascular Surgery. To all these medical achievements, add integrity, courage, honesty, and humility, and the result is a man who will never be forgotten.

The Vineberg legacy: internal mammary artery implantation from inception to obsolescence.

At a time when cardiac surgery was still approached with hesitation, Arthur M. Vineberg developed the procedure of direct implantation of the internal mammary artery into the left ventricle for the relief of myocardial ischemia. The Vineberg operation, as it became known, had merit but never received broad endorsement from the medical and surgical communities. Its physiologic benefits were inconsistent and for years were documented by little more than anecdotal evidence, until coronary angiography (newly developed by Mason Sones) was able to demonstrate that the procedure did in fact increase perfusion in the diseased heart. This supporting evidence came rather late, for within the next decade direct aortocoronary artery bypass grafting overtook the Vineberg operation as a more efficient means of revascularizing the myocardium. Thousands of patients, however, had benefited from internal mammary artery implantation at a time when options were few; and the procedure was an aggressive move towards current (and similarly aggressive) treatments for myocardial ischemia. Moreover, the characteristics of the myocardium that Vineberg sought to exploit may form the basis for future therapy. A reappraisal of the implant is warranted, as today's physicians and surgeons inherit the last remaining recipients of Vineberg implants.

Use of the internal mammary artery in myocardial revascularization.

Internal mammary artery-coronary artery anastomosis is currently considered the newest and best technique for surgical revascularization of ischemic myocardium. The origin and evolution of this technique are reviewed.