In December 1963, Dr. Lester R. Sauvage (1926-2015) of Seattle reports the results of a series of successful surgeries using a vein to bypass part of the coronary artery in dogs. The research, published in the Journal of Thoracic and Cardiovascular Surgery, will make an important contribution to the development of coronary artery bypass surgery, today the most common operation on the heart.
Sauvage had conducted his first experiments with blood-vessel grafts during a residency in vascular surgery at what was then King County Hospital (now Harborview Medical Center) in Seattle in the early 1950s. After completing his surgical training in 1959, he established a private practice as a vascular and cardiac surgeon. He also opened a clinical research laboratory in a small frame house on the grounds of Providence Hospital (now Swedish Medical Center).
In 1962, Sauvage and his associates, at what was initially called the Reconstructive Cardiovascular Research Laboratory (now Hope Heart Institute), began a series of experiments designed to find surgical detours around blockages in the coronary artery. The blockages -- created by deposits of fats, cholesterol, and other substances -- narrow the arterial passageway, reducing blood flow to the heart and causing pain ("angina") and sometimes fatal heart attacks.
Surgeons at that time had few options for the treatment of coronary artery disease. Sauvage and others theorized that segments of a patient’s own veins might be used to create bypasses around the blockages, restoring the flow of blood. The first such attempt on a human patient was made in North Carolina in 1962. The patient died from a stroke. Dubious about the value of the procedure, the researcher (Dr. David C. Sabiston Jr. of Duke University) did not publish details of the case until 1974.
Meanwhile, Sauvage continued his research with animals. He ultimately became the first surgeon to successfully use vein tissue as a substitute for a coronary artery, in experiments with dogs. Although most of the dogs he operated on died as a result of blood clots after the attempted bypass, Sauvage concluded that the procedure was "sound in principle" (Sauvage, 833). He attributed the failure rate in part to the fact that he was using the external jugular vein as a bypass conduit. In human patients, he added, the saphenous vein (in the leg) would be a better choice, because its walls are thicker and the diameter a closer match to the coronary artery.
Sauvage’s results initially met with some skepticism. In a video interview in 2004, he described the reaction when he presented a paper about his experiments at a prestigious medical conference in New York City. "I got up and gave my little song and dance," he said. "I had motion pictures, showing the blood going to the aorta. A very distinguished individual in the field of cardiology got up and squashed me like a bug. He said ‘This is a surgical stunt of no practical significance.’ I’ll never forget that day. But if you think you’ve got something worthwhile, you’ve got to stick with it and do the best you can."
Sauvage himself found his results a little hard to believe. "I was so amazed that it worked," he said.
