Clinical and angiographic outcome of different surgical strategies of bilateral internal mammary artery grafting

Long-term survival, relief of angina, and prevention of myocardial infarcti on after coronary revascularization are related to the preoperative status of the patient, progression of coronary artery atherosclerosis, and the pat ency of the conduits used. The increased use of the internal mammary artery for coronary grafting depends upon the accumulation of data on superior la te patency compared with venous conduits. These data have supported the sim ultaneous use of both left and right internal mammary arteries with reporte d improved late survival. However, controversy still surrounds the clinical and angiographic outcomes of some of the surgical strategies of bilateral internal mammary artery grafting. This review examines a range of surgical strategies of bilateral internal mammary artery grafting and their mid- and long-term clinical and angiographic outcomes. From the available data, car eful preoperative selection of patients is paramount. Clinical and angiogra phic outcome of bilateral internal mammary grafting is superior to single i nternal mammary grafting with supplemental vein grafts when pedicled, seque ntial, or free aorto-coronary internal mammary artery is used. Further stud ies are needed to evaluate the midterm and long-term clinical and angiograp hic outcomes of complex strategies such as Y or T procedures. (C) 2001 by T he Society of Thoracic Surgeons.