CONJOINED DOUBLE INTERNAL MAMMARY ARTERY GRAFTING

Double internal mammary artery (IMA) grafting to the coronary arteries was performed on 82 patients. In ten of them one IMA was used as a fr ee graft, and was proximally connected to the other (''conjoined'' dou ble IMA), the indications being insufficient supply of adequate veins, diseased aortic wall, availability of only a short right IMA segment for free grafting, occluded left subclavian artery, and when distal an d scattered lesions of relatively important vessels had to be bypassed . Additional sequential IMA anastomoses were performed in four patient s and an additional sequential vein graft in a fifth. All patients bec ame angina-free postoperatively and have remained so during observatio n up to 16 months. Recatheterization studies were performed in six pat ients and in all of them the IMA-to-IMA (n = 6) and distal anastomoses (n = 26) were patent. Conjoined double IMA grafting is an important o ption available to the cardiac surgeon for management of selected pati ents with coronary artery disease