ABSTRACT
BACKGROUND: As the internal mammary artery is far superior to the vein in the patency rate recently there has been a tendency to use the arterial graft as much as possible in coronary artery bypass grafts with the expectation of better the short- and long-term patency rate. MATERIAL AND METHOD: We sequentially grafted the diagonal and the left anterior descending artery significantly influencing the cardiac function with the internal mammary artery. There were 32 cases of sequential grafts from July 1993 to December 1998: 21 men and 11 women. The age range was from 43 to 69 years with a mean age of 56.64+/-6.41 years. There were 22 unstable angina 7 stable angina and 3 acute myocardial infarction. 8 cases of them were accompanied by stenosis of the left main coronary artery. The grafts for coronary artery bypass surgery included the great saphenous vein at 60 the right gastroepiploci artery at 5 and the left internal mammary artery at 64 coronary arteries. RESULT: One patient died from sepsis and multiorgan failure. Complications included wound infections in two cases and gastrointestinal bleeding in one patient. All patients showed decrease or disappearance of angina after operation. The postoperative coronary angiogram performed in 9 patients showed neither occlusion nor stenosis of the grafts. CONCLUSIONS: This study suggests that sequential anastomosis of the internal mammary artery to the diagonal and the left anterior descending artery may result in excellent short-term patency diagonal and the left anterior descending artery may result in excellent short-term patency rate and be useful for the coronary artery bypass graft using only arterial grafts.