The clinical and prognostic benefits of coronary artery bypass grafting (CABG) are well accepted for certain subgroups of patients with ischaemic heart disease. Most CABG patients require grafting of the three main native coronary arteries; for the last 15 years the “standard” operation has achieved this using a single internal mammary artery (SIMA) and supplemental vein grafts performed with cardiopulmonary bypass. Although this procedure achieves excellent short and medium term outcome, and over 70% of patients are alive 12 years after surgery,2 the long term results are limited by progressive vein graft failure, therefore, new techniques as using bilateral internal mammary artery (BIMA) grafts.
There have been no randomised trials comparing SIMA and BIMA grafts. Nevertheless, the possibility that BIMA grafts may offer additional clinical and survival benefits to that observed with a SIMA graft has been addressed in several observational studies over the last decade.
The following video presents a coronary angiogram 5 years after surgery, that shows patent SVG to OM2 graft and patent composite BIMA Y-graft. Good feeling of Diagonal and LAD from LIMA and OM1 and PDA from RIMA is seen.
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