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Ann Thorac Surg 1993;56:1136-1140
© 1993 The Society of Thoracic Surgeons

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Articles

Sequential internal mammary artery grafts for coronary artery bypass

^a Divisions of Thoracic and Cardiovascular Surgery, Cardiology, and Nuclear Medicine, University of Miami School of Medicine, Jackson Memorial Medical Center, Miami, Florida USA
^b The Department of Veterans Affairs Medical Center, Miami, Florida USA

Accepted for publication January 25, 1993.

^_* Address reprint requests to Dr Palatianos, Division of Thoracic and Cardiovascular Surgery (R-114), University of Miami School of Medicine, PO Box 016960, Miami, FL 33101.

From 1985 to 1990, 145 patients underwent isolated coronary artery bypass with one (n = 128) or both (n = 17) internal mammary arteries (IMAs) used as sequential bypass grafts. All but 2 patients had angina pectoris preoperatively. A total of 162 sequential IMA grafts were constructed bypassing two (n = 152) or three (n = 10) coronary artery sites as in situ (n = 132) or free (n = 30) grafts. In 12 patients, one IMA was used as a nonsequential graft. Thirty-day mortality was 2.8% (n = 4 patients). Perioperative myocardial infarction occurred in 1 patient (0.7%). Only two sequential IMA grafts failed. Both were used to bypass coronary arteries 1.00 mm in diameter. Mean follow-up was 31 months (range, 6 months to 4.2 years). There were three late deaths. Of 136 survivors followed-up, 121 (89%) were free of angina. Postoperative rotational thallium 201 tomography was done in 73 patients. Myocardial ischemia was detected in 11 diabetic patients (15.1%), but corresponded to a sequential IMA graft in 4 (5.5%) and to nonsequential and venous grafts in 10 patients (13.7%). Coronary revascularization with sequential IMA grafts was safe and effective.

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