The left internal mammary artery as a sequential graft to the left anterior descending system.

The left internal mammary artery (IMA) has been used as a sequential graft to the left anterior descending (LAD) system in 39 patients. Seven patients having operation in 1977 were followed up for 2 years, and cardiac catheterization in four revealed no problems related to the anastomoses. After a 2 year hiatus we resumed use of the procedure in 1980. A total of 10 patients have had catheterization from 1 month to 5 years postoperatively with no anastomotic narrowing or restriction of distal IMA flow by the side-to-side anastomosis. The IMA should be equal to or greater in size than the larger of the two vessels to be grafted. We continue to use this procedure in carefully selected patients.