[The internal mammary artery in myocardial revascularization]

Internal mammary artery by-pass graft is a very usefull alternative to venous by-pass graft for myocardial revascularization. From February 1982 up to August 1984, 111 patients with coronarosclerosis have been operated on with left internal mammary artery. Right internal mammary artery has been also used in 2 cases. Left internal mammary artery has been used as a sequential graft 13 times. Vein grafts have been associated in more than 2/3 of the patients who had surgery with internal mammary artery and the mean of anastomoses per patient was 2.9. Five patients had a perioperative myocardial infarction and one an infarction shortly after the operation. Ten patients had immediate reoperation: 5 for postoperative bleeding, 2 for arterial graft anastomosis occlusion, 2 for sudden ST elevation and 1 for acute myocardial infarction. Only one patient died for acute myocardial infarction post-operatively, following coronary artery spasm. Eighty-six patients have been followed-up 3 to 31 months after surgery. Advantages and limits of this surgical technique are discussed.