SEQUENTIAL INTERNAL MAMMARY ARTERY GRAFTS FOR CORONARY-ARTERY BYPASS

From 1985 to 1990, 145 patients underwent isolated coronary artery byp ass with one (n = 128) or both (n = 17) internal mammary arteries (IMA s) used as sequential bypass grafts. All but 2 patients had angina pec toris preoperatively. A total of 162 sequential IMA grafts were constr ucted bypassing two (n = 152) or three (n = 10) coronary artery sites as in situ (n = 132) or free (n = 30) grafts. In 12 patients, one IMA was used as a nonsequential graft. Thirty-day mortality was 2.8% (n = 4 patients). Perioperative myocardial infarction occurred in 1 patient (0.7%). Only two sequential IMA grafts failed. Both were used to bypa ss coronary arteries 1.00 mm in diameter. Mean follow-up was 31 months (range, 6 months to 4.2 years). There were three late deaths. Of 136 survivors followed-up, 121 (89%) were free of angina. Postoperative ro tational thallium 201 tomography was done in 73 patients. Myocardial i schemia was detected in 11 diabetic patients (15.1%), but corresponded to a sequential IMA graft in 4 (5.5%) and to nonsequential and venous grafts in 10 patients (13.7%). Coronary revascularization with sequen tial IMA grafts was safe and effective.