Techniques for multiple internal mammary artery bypass grafts

Long-term patency of the internal mammary artery graft surpasses that of all other bypass conduits. The use of multiple internal mammary artery grafts should improve the long-term results following coronary artery bypass grafting. Technical factors used in mobilizing, preparing, and anastomosing the internal mammary artery are discussed in this article. Fifty-three patients received sequential attached left internal mammary artery grafts from April, 1982, to August, 1983. In 6 of these patients, the right internal mammary artery was anastomosed to a circumflex marginal branch. There were no operative deaths or instances of low cardiac output. One patient suffered anastomotic narrowing that possibly could have been prevented by excision of excess tissue from the internal mammary artery pedicle. Multiple internal mammary artery grafting should have a profound influence on the results of coronary artery bypass grafting.