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The Annals of Thoracic Surgery, Vol 58, 74-78, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Five-year follow-up of microsurgical multiple internal thoracic artery grafts

GE Green, A Cameron, A Goyal, SC Wong and J Schwanede
Division of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center, New York, New York.

In a consecutive series of 143 patients requiring multiple coronary artery bypass grafts, 317 of 441 anastomoses (72%) were constructed from internal thoracic arteries. Of these 143 patients, 103 had bilateral, 51 sequential, and 49 free internal thoracic artery grafts. When compared with an earlier series of 494 patients who underwent only one internal thoracic artery anastomosis, the surgical morbidity and mortality were not increased, but, during 5 years of follow-up, the incidences of postoperative angina and myocardial infarction were found to decrease significantly--32.5% versus 10.5% (p < 0.001) and 5.7% versus 1.4% (p < 0.03), respectively. We conclude that, for patients with multivessel disease, multiple internal thoracic artery grafts confer better protection from the clinical manifestations of ischemic heart disease than does one internal thoracic artery graft. The use of high magnification (8 to 12x, surgical microscope) was essential to the success of this method.