Coronary Artery Bypass Grafting: Case Histories of Significant Medical Advances

Amar  Bhide; Srikant M. Datar; Fabio  Villa

Working Paper | HBS Working Paper Series | 2019

Coronary Artery Bypass Grafting: Case Histories of Significant Medical Advances

by Amar Bhide, Srikant M. Datar and Fabio Villa

Abstract

We describe how Coronary Artery Bypass Grafting (CABG, or more popularly, “bypass”) operations revolutionized the treatment of coronary disease (that can produce fatal heart attacks and debilitating angina). Specifically we chronicle the 1) development of the foundational procedures and technologies that provided a base for CABG; 2) early CABG operations performed in the 1960s; 3) rapid—and controversial growth—that occurred in the U.S. in the 1970s and; 4) emergence and rapid diffusion of the less invasive angioplasty alternative that slowed the growth of CABG in the last two decades of the 20th century.

Keywords: Health Care and Treatment; Technological Innovation; Innovation Strategy; Technology Adoption; Collaborative Innovation and Invention; Innovation and Invention; Governing Rules, Regulations, and Reforms;

Language: English

Format: Print

42 pages

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Citation:

Bhide, Amar, Srikant M. Datar, and Fabio Villa. "Coronary Artery Bypass Grafting: Case Histories of Significant Medical Advances." Harvard Business School Working Paper, No. 20-010, July 2019.

We describe how Computed Tomography (CT) scanners—that combine x-rays and computers to image soft tissues of the brain and other organs—have become a widely used diagnostic tool. Specifically, we chronicle the following: 1) development of the first CT scanner (through the early 1970s); 2) rapid and enthusiastic adoption of CT scanning (until the late 1970s); 3) regulatory backlash against the perceived overuse of this expensive technology (in the 1980s); and 4) innovations that reignited growth (in the 1990s and 2000s).

We describe how a chance discovery of bacteria that infects stomach linings completely changed how physicians treat ulcers. Specifically, we chronicle how 1) two Australian physicians brought the bacterial infection to the world’s attention and challenged the conventional view that stomach acidity caused ulcers; 2) a global community of researchers helped corroborate the Australians’ findings and developed convenient tests and effective treatments; and 3) these tests and treatments were gradually, but not immediately, adopted.

We describe how endoscopy transformed the diagnosis of ulcers, cancerous polyps, and other diseases of the alimentary canal and enabled “minimally invasive” surgeries to treat such diseases. Specifically, we chronicle how 1) flexible glass fiber endoscopes developed in the 1950s and 1960s provided the foundation; 2) technical advances—promoted by evangelical innovators—in the 1970s and early 1980s enabled new diagnostic techniques and minimally invasive abdominal surgeries; 3) radical and incremental improvements through the end of the 20th century sustained growth—although they did not enable many new procedures; and 4) capsule endoscopes containing miniaturized cameras that patients swallowed provided another breakthrough in the first decade of the 21st century.

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Coronary Artery Bypass Grafting: Case Histories of Significant Medical Advances

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