PROGRESS during the past decade in the surgical treatment of atherosclerotic coronary heart disease has not been commensurate with the spectacular advances made in the correction of most congenital cardiac defects and many acquired lesions of the cardiac valves and great vessels. The problem of coronary insufficiency has continued to provide a profound challenge to the best efforts of the cardiologist and the cardiac surgeon alike. Although new drugs have been developed to decrease thrombosis and to modify or control anginal pain and arrhythmias, these have not provided a significantly increased coronary blood flow in partially obstructed arteries. The gravity of the problem and the urgent need for its solution are reflected in the public health statistics of several countries which reveal this disease to be the principal cause of death in the adult population.
The concept of vascularizing the myocardium directly from an artificially created shunt was introduced almost