Myocardial revascularization with skeletonized left mammary artery.

Graft selection has a direct influence on overall morbidity and mortality in patients selected for coronary artery bypass grafting (CABG) procedures. In the last decade internal mammary artery has been established as a conduit of choice for myocardial revascularization. However, there is still no official policy which operative technique has advantage in harvesting of the internal mammary artery (IMA). Current dilemma is whether pedicle or skeletonized grafts are better in immediate and long term results. Method of skeletonization of IMA increases surgeon's technical demands, but on the other hand has many advantages. Precise operative technique and selective preparation of IMA without concomitant elements reduces trauma to the chest wall, enables elongation and ideal graft positioning, and reduces graft compression by hyperinflated lungs. Complete graft visualization allows inspection of internal mammary artery in entire length, which excludes possibility to implant dissected or hypoplastic graft. From June 1996 we started using the method of skeletonization of IMA, and until February 1st 1999 skeletonized IMA was used as a conduit in 1001 patients. In our hands myocardial revascularization with IMA is a procedure with minimal morbidity and mortality. Precise operative technique during the harvesting of IMA is advantage especially in diabetics, old patients and patients with chronic obstructive pulmonary disease (COPD), that were considered as limiting factors for IMA use in the past. Our initial results with the quality of this conduit encourage us to extend the indication for using IMA as a dominant graft in multiple myocardial revascularization.