Sequential mammary artery grafts in one hundred and twenty consecutive patients: indications, operative technique, 6 months postoperative functional and angiographic controls.

In the hope of establishing the internal mammary artery (IMA) as a true but superior substitute for the saphenous vein (SV) we reviewed our initial experience in complex IMA grafting. The first 120 consecutive patients, having received at least one sequential IMA graft were analyzed. The length of the IMA pedicle was the only limitation imposed on its use. Technical artifices enhancing the versatility of the IMA are described. The significant peri-operative myocardial infarction rate was 3.3%. There was no cardiac operative mortality, and 1 late mortality (0.8%). Excellent functional results were illustrated by a 2.5% rate of residual angina and dyspnoea. Six months postoperative angiographic controls could be performed in 70% of the patients: all of the sequential mammary conduits were patent, as were 95% of the anastomoses. By contrast 87.2% of the concomitant venous anastomoses were still functioning. With the expanding utilization of the free graft, IMA is expected to become a true, better and all round substitute for the saphenous vein.