18 Innovations: First Coronary Artery Bypass

Performed first in 1967, this common procedure has relieved countless patients from the pain of angina

Rene Favaloro, MD, came to Cleveland Clinic without an invitation. He was a rural doctor from Argentina who wanted to learn from Cleveland Clinic’s famed surgeons. It was the early 1960s. Dr. Favaloro made friends with renowned surgeon George Crile, Jr., MD, and F. Mason Sones, MD, the discoverer of coronary angiography. They welcomed the eager, hardworking young man.

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Dr. Favaloro studied at the elbow of pioneers like Cleveland Clinic heart surgeon Donald Effler, MD, and cardiologist William Proudfitt. Cleveland Clinic surgeons were already treating ischemic heart disease by implanting the left internal mammary artery into the muscle of the left ventricle. This technique, called the Vineberg procedure, sometimes led to revascularization, although with inconsistent and unpredictable results. Something better was clearly needed.  Dr. Favaloro pored over Dr. Sones’ collection of angiograms and plotted a new surgical approach.  Here is what happened next, according to the New York Times (August 1, 2000): “On Nov. 30, 1967 … he performed an operation at the Cleveland Clinic on a patient with a potentially deadly coronary artery blockage. After stopping the heart, Dr. Favaloro took a section of vein from the patient’s leg and sewed one end to his aorta. Then, much the way a driver might use a side road to go around a traffic jam, Dr. Favaloro attached the other end to the blocked artery, beyond the blockage.”  This was the first saphenous vein coronary artery bypass graft – soon to become one of the most widely performed major surgeries in the world. While other surgeons claimed to have done similar grafts earlier, the New York Times says, “Dr. Favaloro was the first to systematically plot and perform the procedure and publish his results” – performing post-surgical angiography to document improved blood flow and reporting the outcomes in a peer-reviewed medical journal.

A modest man of deep feeling, Dr. Favaloro shared the credit for his singular achievement. “We is more important than I,” he once wrote. “In medicine, the advances are always the result of many efforts accumulated over the years.” Dr. Favaloro returned his native Argentinain 1971 to found a heart care clinic on the model of Cleveland Clinic and financed with his own money. His death in 2000 was mourned around the world.

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