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Sequential coronary artery bypass utilizing the internal mammary artery
1Department of Surgery, Ochsner Clinic, New Orleans, LA.
Fifty consecutive patients underwent sequential bypass grafting of diseased coronary arteries using the left internal mammary artery (IMA) as a sequential bypass graft. There were no perioperative myocardial infarctions, and follow-up from 3 to 5 years revealed that all 50 patients are living and are free of angina. Technical aspects for use of the internal mammary artery as a sequential graft to two or more coronary arteries is technically a feasible procedure when certain guidelines are followed. We advise its use primarily for left anterior descending/diagonal connections and avoid its use when there is a wide angle between the latter vessels to avoid kinking. The distal end-to-side IMA anastomosis is always performed first to the most important coronary artery. With this approach if there is a problem with length or lie of the IMA graft, the sequential anastomosis to the lesser important coronary artery may be aborted. The side-to-side technique is used most often. Postoperative angiograms in 11 patients have revealed no evidence of stenosis, occlusion, or late ill effects.
Fifty consecutive patients underwent sequential bypass grafting of diseased coronary arteries using the left internal mammary artery (IMA) as a sequential bypass graft. There were no perioperative myocardial infarctions, and follow-up from 3 to 5 years revealed that all 50 patients are living and are free of angina. Technical aspects for use of the internal mammary artery as a sequential graft to two or more coronary arteries is technically a feasible procedure when certain guidelines are followed. We advise its use primarily for left anterior descending/diagonal connections and avoid its use when there is a wide angle between the latter vessels to avoid kinking. The distal end-to-side IMA anastomosis is always performed first to the most important coronary artery. With this approach if there is a problem with length or lie of the IMA graft, the sequential anastomosis to the lesser important coronary artery may be aborted. The side-to-side technique is used most often. Postoperative angiograms in 11 patients have revealed no evidence of stenosis, occlusion, or late ill effects.