Direct Anastomosis of the Bilateral Internal Mammary Artery to the Distal Coronary Artery, Without a Magnifier, for Severe Diffuse Coronary Atherosclerosis

Abstract

Forty-three cases of direct anastomosis of unilateral or bilateral internal mammary artery (IMA) and distal coronary artery (DCA), with or without saphenous vein graft (SVG), for severe, diffuse, ischemic coronary artery disease are reported. The technique of anastomosis of IMA and DCA without a magnifier or microscope is discussed in detail. The operative mortality was less than 5% (2 of 43 patients). The initial patency rate of IMA and DCA anastomosis was 97% (34 of 35). Only 8 patients have been restudied 4 to 16 months after surgery. Flow through the IMA ranged from 30 to 60 cc/min, averaging 45 cc/min at the time of surgery. Postoperative ventricular function studies suggest an increase of left ventricular emptying and endocardial fiber-short-ening rate in those with well-functioning grafts. The significant advantage of this technique is that it extends the indications for direct coronary artery reconstruction by anastomosing bilateral IMA to DCA near the apex, where the size of the artery is 1 to 1.5 mm and the SVG is more likely to occlude because of the size discrepancy and expected relatively low blood flow.