[Arterial coronary bypass].

The long-term patency of internal mammary artery grafts used for myocardial revascularization bypass surgery is the main reason arterial grafts have largely replaced saphenous vein grafts. Indeed after 10 years, venous grafts often occlude or develop major atheromatous wall lesions. Use of an internal mammary artery graft for myocardial revascularization on the anterior interventricular coronary artery has thus greatly improved the beneficial effect of coronary bypass surgery. Several surgical teams have attempted to further improve results by using two internal mammary arteries or even other arterial grafts. This evolution towards "arterial coronary surgery" have nevertheless been criticized by some due lower than expected permeability rates and increased post-operative morbidity. Most surgical teams in France have thus maintained their preference for single internal mammary grafts and several saphenous vein grafts. Unlike these teams, we believe that the use of two internal mammary grafts together with other arterial grafts does not increase surgical risk and provides better quality long-term myocardial revascularization than do conventional procedures. It is important however to select patients for arterial surgery among those with a good general health status susceptible of benefiting from the long-term permeability of mammary artery grafts.