The internal mammary artery bypass graft: praise versus practice

Patency rates and long-term clinical results after coronary artery bypass are superior when the internal mammary artery, rather than the saphenous vein, is used as a bypass graft. Four thousand forty-seven cardiac surgeons were surveyed to assess their theoretical preference of bypass graft, in comparison to their actual practice. The 750 surgeons performing myocardial revascularization who completed the questionnaire had done approximately 122,652 coronary artery bypass operations annually. Six hundred twenty-nine (84%) listed the internal mammary artery as the graft of choice for bypassing the left anterior descending coronary artery, whereas 114 (15%) listed the saphenous vein. Only about half (56%) of the surgeons actually used the internal mammary artery commonly, however, and only 228 (30%) used it in at least 90% of their operations. In actual practice, then, the internal mammary artery is often avoided in situations where it could be used as a coronary artery bypass graft. This practice can be expected to have a negative influence on late postoperative results. (The Texas Heart Institute Journal 1987; 14:139-143)