Double Internal Mammary Artery-Myocardial Implantation

A total of 248 double internal mammary artery-myocardial implantations have been performed at the Cleveland Clinic up to October 31, 1967. This report presents an analysis of the clinical experience with the first 150 patients. The majority of the patients were between 40 and 60 years of age. The overall hospital mortality was 9.3%. The lowest mortality rate (4.9%) was among patients between 51 and 60 years of age. The most common complication encountered in this series (22 patients) was atrial fibrillation. Acute myocardial infarction developed in 14 patients; all of them recovered with the usual medical treatment. All of the patients have been studied by Sones's technique of selective coronary angiography and left ventriculography. We believe that this is mandatory in the selection of patients for coronary artery operations. The postoperative evaluation shows significant clinical improvement in the majority, 116 patients. Thirty-one have undergone postoperative angiographic studies. Of 61 opacified arteries, 58 remained patent, and 37 showed definite communication with coronary arteries. We believe our present operative technique allows us to increase myocardial perfusion in any region of the left ventricle.