5-YEAR FOLLOW-UP OF MICROSURGICAL MULTIPLE INTERNAL THORACIC ARTERY GRAFTS

In a consecutive series of 143 patients requiring multiple coronary ar tery bypass grafts, 317 of 441 anastomoses (72%) were constructed from internal thoracic arteries. Of these 143 patients, 103 had bilateral, 51 sequential, and 49 free internal thoracic artery grafts. When comp ared with an earlier series of 494 patients who underwent only one int ernal thoracic artery anastomosis, the surgical morbidity and mortalit y were not increased, but, during 5 years of follow-up, the incidences of postoperative angina and myocardial infarction were found to decre ase significantly-32.5% versus 10.5% (p < 0.001) and 5.7% versus 1.4% (p < 0.03), respectively. We conclude that, for patients with multives sel disease, multiple internal thoracic artery grafts confer better pr otection from the clinical manifestations of ischemic heart disease th an does one internal thoracic artery graft. The use of high magnificat ion (8 to 12x, surgical microscope) was essential to the success of th is method.