The internal mammary artery (IMA) remains firmly established as the conduit of choice for coronary artery revascularization procedures. Internal mammary artery grafts have better long-term patency than vein grafts and are associated with longer patient survival and a lower rate of reoperation. Furthermore, the IMA performs as well when used as a sequential or free graft as when it is grafted to a single coronary artery as an in situ graft. These excellent results have encouraged surgeons to perform bilateral IMA grafts. Recent studies have defined limitations on this technique and have demonstrated an increased frequency of complications when it is performed.
Fiore et al1 studied patients who were undergoing coronary revascularization with either single or double IMA grafts. At a mean follow-up of 14.4 years, the double IMA group had a significantly better freedom from recurrent angina and myocardial infarction. Reoperation rates were not different, and survival benefits
Lupinetti FM, Behrendt DM. Cardiothoracic Surgery. JAMA. 1990;263(19):2627–2629. doi:10.1001/jama.1990.03440190083043