Extended Use of the Internal Mammary‐Coronary Artery Bypass

Extended use of the IMA for routine coronary bypass grafting should do much to reduce the eight- to ten-year failure rate seen so frequently with the saphenous vein graft. However, considerable judgment is necessary for its proper use in a large number of situations and the performance of multiple sequential IMA anastomoses is technically more difficult than with saphenous veins. Special instruments have been devised to improve handling and suturing of the IMA and, as with the saphenous vein graft operation, performance of these anastomoses will be improved with increased experience. Extended use of the IMA is the operation of choice for younger patients with good left ventricular function and offers significant advantages to a group of patients that stands to benefit most by preventing both early and late conduit failure.