Use of the internal mammary artery for myocardial revascularization
Manuel J. Irarrazaval, M.D.
Department of Thoracic and Cardiovascular Surgery
Selecting the optimal graft for direct myocardial revascularization has been the aim of cardiac surgeons since the technique was established in 1967.
The saphenous vein graft that was used originally proved to be a reliable material. However, despite increasing technical sophistication, the patency rate has remained between 70% and 82% in men and 10% to 15% lower in women.1–4
In 1950, Vineberg implanted the internal mammary artery (IMA) in the myocardium and observed significant clinical improvement, but it was not until 1959 that Sones5 demonstrated by coronary angiography the development of communication between the IMA and the coronary system in some patients. In 1964, Kolessov6 first performed a direct anastomosis between the IMA and the coronary artery for treatment of angina pectoris. Initially, coronary angiography was not available to evaluate his results. In 1968, Green7 successfully performed IMA anastomosis and reported his results with 165 clinical cases in 1971. That same year, Loop et al8 modified the technique for constructing IMA anastomosis without high power optical assistance.
In the past 5 years the IMA has become a popular alternative for myocardial revascularization, even though the technique is more difficult than that for saphenous vein grafting. This relative disadvantage has been outweighed by the higher patency rate, the necessity of only one anastomosis, and the excellent clinical results. The reason for the higher patency rate is probably related to less discrepancy between the size of the IMA and the size of the coronary arteries, or the smaller diameter of the. . .