Myocardial revascularization by bilateral internal mammary artery implantation. Experimental and clinical data

Laboratory experimentation demonstrated widespread myocardial revascularization after bilateral internal mammary artery implantation and concomitant triple coronary ameroid occlusion. The feasibility of operating on patients with severe triple coronary artery disease and myocardial failure in need of widespread myocardial revascularization is described. The patients in this series were failing in spite of competent medical therapy and were considered from all aspects as a salvage group of patients with progressive coronary artery disease. No patient was refused operation on the basis that the disease process was too severe. There was no question before operation that these patients needed additional myocardial circulation, but we did question whether the operative risk might be prohibitive or the degree of myocardial damage too extensive to allow any worthwhile result.Unfortunately, preoperative enzyme and metabolic studies did not appear to be sufficiently accurate in determining the extent of the myocardial damage or whether sufficient functioning myocardium remained. As a consequence, operation was undertaken in this pilot group of patients to determine risk and results. It is realized that the time interval after operation is too short to allow a proper evaluation of the benefits obtained. Cineangiographic evaluation performed in 15 patients from three to five months postoperatively revealed 28 of the 30 implanted internal mammary arteries to be patent. Sixteen of these vessels demonstrated new anastomotic channels between the implant and the diseased coronary arteries. An additional 6 patients had new anastomotic channels between the extracardiac portion of the internal mammary arteries and the coronary arteries.A new cineangiographic technic for determining postoperative volume flow through the internal mammary arteries, described in detail in another article, was employed in 4 patients. A significant amount of additional blood flow to the ischemic myocardium was demonstrated by these studies.