[Multiple anastomosis with the internal mammary arteries]

Between February 1984 and June 1985 90 consecutive patients underwent a surgical procedure of myocardial revascularization with multiple anastomoses, using one or both internal mammary arteries by single or sequential anastomoses. In 53 cases venous graft were also used. 86 cases had elective surgery and 4 had emergency surgery for unstable angina. Most of the patients had triple vessels disease; left main stenosis was present in 14. Left ventricular ejection fraction was less than 0.35 in 8 cases. A single internal mammary artery was used in 61 patients with sequential anastomoses; in 3 of these a triple sequential anastomoses was performed. In 29 patients both mammaries were used, 6 of these were anastomosed in double sequential way. Right mammary was always sewn on the marginal branch of the circumflex artery through the transverse sinus. The incidence of perioperative myocardial infarction was 2.2%. There was no hospital mortality. Reparative surgery to control immediate postoperative bleeding was required in 5 patients (5.5%). 5 cases presented a wound infection. 32 sequential anastomoses were restudied angiographically: 30 of these were patent and 2 malfunctioning. There were two late deaths: one 5 months postoperative, for gastric hemorrhage and the second one 6 months after surgery for inferior myocardial infarction. Mean follow-up of 10 months was complete in 88 surviving patients of whom 80 (91%) were asymptomatic, and 8 cases had residual angina: 5 only during exercise, 3 at rest. We conclude that the extended use of the internal mammary artery grafting, as single or sequential anastomoses, is technically feasible and provides adequate perfusion to the area of myocardium supplied by such grafts.