Technical Considerations and Early Results of Sequential Left Internal Mammary Artery Bypass Grafting to the Left Anterior Descending Coronary Artery System

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Abstract
The use of the internal mammary artery (IMA) as a coronary artery bypass graft conduit has recently been expanded to include sequential bypass grafting of multiple vessels. This has the theoretical advantage of allowing a greater percentage of myocardium to be revascularized with a conduit that has superior long-term patency rates. This article reviews technical considerations including maximizing IMA graft length and diameter, avoidance of an acute mediastinal or epicardial course, as well as anastomotic techniques for optimizing results of sequential IMA bypass grafting to the left anterior descending coronary artery system.

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