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[Myocardial revascularization. Historical review].

Atherosclerotic coronary artery disease is the main cause of death among the adult population in developed countries. Therefore, its surgical treatment has special importance and relevance. Surgery for coronary artery disease has evolved spectacularly since its inception in clinical practice. Indirect revascularization procedures had their foundations in medical concepts with more than a doubtful scientific basis. Clinical results used to be poor and unpredictable and the older techniques were slowly abandoned. Many newer techniques appeared in an attempt to improve the results. The implantation of the left internal mammary artery directly in the left ventricular myocardium through a tunnel deeply drilled within the muscle mass was later developed. It was initially thought that this method could supply an important amount of blood to the diseased myocardium. Clinical results were encouraging and postoperative mammary angiography showed definite connections with the coronary arterial tree; however this only happened in a small number of patients. Direct myocardial revascularization was attempted in order to restore the oxygenated blood supply to the myocardium. Patches, endarterectomies and bypass grafts were constructed and clinical results showed them to be safe and their outcomes could also be objectively assessed.