Conjoined double internal mammary artery grafting.

Double internal mammary artery (IMA) grafting to the coronary arteries was performed on 82 patients. In ten of them one IMA was used as a free graft, and was proximally connected to the other ("conjoined" double IMA), the indications being insufficient supply of adequate veins, diseased aortic wall, availability of only a short right IMA segment for free grafting, occluded left subclavian artery, and when distal and scattered lesions of relatively important vessels had to be bypassed. Additional sequential IMA anastomoses were performed in four patients and an additional sequential vein graft in a fifth. All patients became angina-free postoperatively and have remained so during observation up to 16 months. Recatheterization studies were performed in six patients and in all of them the IMA-to-IMA (n = 6) and distal anastomoses (n = 26) were patent. Conjoined double IMA grafting is an important option available to the cardiac surgeon for management of selected patients with coronary artery disease.