The role of the sequential internal mammary artery graft in coronary surgery

The use of sequential internal mammary artery grafts is a possible method of improving overall long-term graft patency in patients receiving coronary artery bypass grafts. Twenty-nine patients who had sequential grafts were studied. The left internal mammary artery was anastomosed side-to-side to the diagonal and end-to-side to the left anterior descending coronary artery (LAD) in 24 patients, side-to-side to the proximal LAD and end-to-side to the distal LAD for proximal and midvessel obstruction in four patients, and in one patient the left internal mammary artery was grafted side-to-side to the first marginal branch of the circumflex artery and end-to-side to the second marginal branch. There were no operative deaths, but one patient died 10 months after surgery from viral pneumonia. There was no evidence of left ventricular failure. None of the patients suffered perioperative myocardial infarction or return of their angina. Eleven patients underwent postoperative stress tests and results were negative in all. Graft visualization in three patients showed patent grafts without kinking or narrowing. These findings suggest that the sequential internal mammary artery graft is safe and should improve overall long-term patency. We particularly recommend its use in the younger patient.