Long-term outcome of revascularization of the anterior coronary arteries with crossed double internal mammary versus saphenous vein grafts

When simultaneous revascularization of the left anterior descending (LAD) artery and the proximal segments of the diagonal LAD and marginal coronary arteries is required, the direction and location of these vessels allow excellent alignment of the left internal mammary artey (IMA) with the LAD and the right IMA with the diagonal LAD or marginal arteries, an approach originally described in 1976. To analyze and compare the long-term outcome of this approach versus the saphenous vein bypass graft (SVG) approach for anterior coronary revascularization, we reviewed 43 patients who had these crossed double IMAs (CDIMAs) and 53 patients who had SVGs to the same obstructed anterior coronary arteries during 1973 to 1978; 32 patients in the CDIMA group and 43 in the SVG group also had SVGs to other diseased vessels. The two groups had similar demographic and epidemiologic characteristics. The linearized incidence of late cardiac death, reoperation, recurrent angina, and infarction was 0.2%, 0.7%, 1.4%, and 0% per patient-year, respectively, in the CDIMA group, and 1.6%, 2.4%, 7.8%, and 1.8% per patient-year in the SVG group (p < 0.01 for each event). At 5 years, the actuarial number of patients with CDIMAs free of late cardiac death was 100%, of reoperation 98%, of recurrent angina 98% (p < 0.01), and of infarction 100% (p < 0.01), versus 94%, 98%, 84%, and 94%, respectively, in the SVG group. At 10 years, the actuarial incidence of all events was substantially and significantly less in patients with CDIMAs. CDIMAs have significantly better prognostic effects than SVGs when revascularization of the anterior coronary arteries is required. This is currently our preferred approach in these selected patients.