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The use of the left internal mammary artery (LIMA) to bypass the left anterior descending artery (LAD) is the “gold standard” of coronary artery revascularization, recognized by interventionalists and surgeons alike. The better size match with the coronary artery, the single anastomosis, and the biochemical and physical qualities of this conduit for the most important coronary artery in the human circulation, the LAD, are clear advantages over the saphenous vein graft.1 The seminal paper by Loop et al2 showed the important influence of this operation on the longevity of patients who are operated on for coronary artery disease, and their data have been substantiated by others.3 4 Nevertheless, the IMA has not been generally used by surgeons in the variety of clinical coronary artery syndromes requiring coronary artery bypass grafting (CABG) because of some relative contraindications. These have included left ventricular hypertrophy, severe left ventricular dysfunction, emergency operations, chronic obstructive pulmonary disease with enlarged lungs, advanced age, and an obstructed left subclavian artery.4 Theoretically, increased conduit blood flow …

Use of the Internal Mammary Artery Graft and In-Hospital Mortality and Other Adverse Outcomes Associated With Coronary Artery Bypass Surgery