title: Sequential internal mammary artery grafts for coronary artery bypass.
abstract: From 1985 to 1990, 145 patients underwent isolated coronary artery bypass with one (n = 128) or both (n = 17) internal mammary arteries (IMAs) used as sequential bypass grafts. All but 2 patients had angina pectoris preoperatively. A total of 162 sequential IMA grafts were constructed 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 bypass 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 rotational thallium 201 tomography was done in 73 patients. Myocardial ischemia 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 sequential IMA grafts was safe and effective.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Miami School of Medicine, Florida 33101.
authors.forename: G M
authors.initials: GM
authors.lastname: Palatianos
authors.forename: H
authors.initials: H
authors.lastname: Bolooki
authors.forename: M D
authors.initials: MD
authors.lastname: Horowitz
authors.forename: M H
authors.initials: MH
authors.lastname: Lowery
authors.forename: S P
authors.initials: SP
authors.lastname: Rosenthal
authors.forename: S K
authors.initials: SK
authors.lastname: Chandarlapaty
authors.forename: G N
authors.initials: GN
authors.lastname: Sfakianakis
authors.forename: G A
authors.initials: GA
authors.lastname: Kaiser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D015996:Survival Rate