Bilateral internal mammary artery implants
Rene G. Favaloro, M.D.
Department of Thoracic and Cardiovascular Surgery
INTERNAL mammary artery implantation is the most reliable method of increasing myocardial circulation. More than 500 patients have under-gone left internal mammary artery implantation at the Cleveland Clinic Hospital, and postoperative studies have shown that 90 percent of the arteries stay open with various degrees of collateral circulation. However, one internal mammary artery alone cannot bring about revascularization of the entire left ventricle. At the most, the left internal mammary artery can perfuse the anterolateral wall of the left ventricle. A significant number of patients had severe diffuse disease with involvement of the right coronary artery and the anterior ascending and circumflex branches of the left coronary artery. In those patients, revascularization of the diaphragmatic wall of the left ventricle is mandatory. Since July of 1966, a new operative technic has been developed, which allows bilateral internal mammary artery implantation in the left ventricle.
With the patient in the supine position, a median sternotomy is performed (Fig. 1). The incision is extended halfway between the end of the sternum and the umbilicus to obtain the necessary length. With a new retractor (Fig. 2) first the left side of the sternum is lifted, giving good exposure of the left internal mammary artery (Fig. 3) that is dissected as Sewell and Davalos1 have previously described. This dissection is believed to be less traumatic and gives more protection to the artery than does the original Vineberg2 operation. The mammary artery is completely detached from the sternum, cephalad up to the entrance of . . .