[Coronary revascularization with the double internal mammary artery].

From January 1989 through December 1991, 730 patients (mean age 60.4 years) underwent coronary revascularization. In 124 patients (17%), with a mean age of 51.8 +/- 7.9 years, both internal mammary arteries (IMA) were used. Of these, 19 (15%) had diabetes mellitus and 11 (9%) were obese, and 72 (58%) had history of myocardial infarction. Fifty three (45%) patients were in class III and 17 (14%) were in class IV (Canadian Cardiovascular Society), and 27 (22%) had moderate to severe left ventricular dysfunction. Ten (8.1%) patients had left main stem coronary artery disease and 5 (4.0%) had a left ventricular aneurysm. The total number of distal anastomoses performed was 382 (3.1/patient). In 87 (70%) patients one or more saphenous vein grafts (1.2/patient) were used in addition to both mammary arteries. Hence, 279 distal anastomoses were constructed using arterial conduits (2.3/patient). In one patient the right gastroepiploic artery was also used. The venous grafts were predominantly (71%) constructed to the right coronary artery. The left IMA was used as a free graft in 3 (2.3%) patients and as a pedicled graft in the remainder patients, predominantly to the territory of the left anterior descending artery and its diagonal branches (92%). The right IMA was used as a free graft in 100 (81%) patients, mainly to the territory of the circumflex coronary artery and as a pedicled graft in 24 patients, in 21 to the territory of right coronary artery. Thirty nine (31%) patients required endarterectomy of the right coronary artery. Mean cardiopulmonary bypass time and mean duration of aortic cross-clamping were 78.6 minutes and 29.6 minutes, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)