Fifteen-year follow-up for double internal thoracic artery grafts

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Abstract
The internal mammary artery (IMA) is the conduit of choice formyocardial revascularization. From 1972 to 1989, 586 patients receivedbilateral IMA and supplemental vein grafts. There were 506 men (86%) and 79women (14%) with a mean age of 55.5 years (range 32-77 years). Unstableangina was present in 138 patients (24%), insulin-requiring diabetesmellitus in 83 (14%) and previous myocardial infarction (MI) in 25 (4%).Preoperative angiography demonstrated triple-vessel disease in 286 patients(49%) and double-vessel disease in the remaining 300 patients (51%). Leftmain coronary artery disease (stenosis greater than or equal to 50%) waspresent in 53 (9%). The mean left ventricular score was 7.4 with a range of5 to 20. The mean number of grafts performed was 3.4 per patient. Hospitalmortality was 3.6% (21 patients). Follow-up was done through direct patientcontact, via the patient's physician or by telephone contact with thepatient themselves or surviving family members. Follow-up was complete in518 hospital survivors and ranged from 1 month to 17.5 years with acumulative follow-up of 911 patient years. At 10 and 15 years,respectively, the actuarial freedom from MI was 78% and 72% and freedomfrom reoperation was 93% and 86%. Actuarial survival at 10 and 15 years was85% and 70%, respectively. This longitudinal analysis demonstrates thatbilateral IMA grafting has a low operative risk. The data suggest thatutilization of two IMA grafts yield excellent freedom from recurrentsymptoms and provides excellent long-term survival.

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