We conclude that concomitant use of the gastroepiploic artery with both ITAs results in low mortality and a low incidence of myocardial infarction and reintervention at follow-up. Most interestingly, we found 85.4% freedom from angina pectoris after 7 years, which is considerably lower than the results of studies in which vein grafts, single ITA grafts, or double ITA grafts are used. These results strongly support the use of both ITAs and the right gastroepiploic artery for bypass grafting in patients with 3-vessel disease.

We conclude that the concomitant use of the gastroepiploic artery with the both internal thoracic arteries has low morbidity and mortality in patients with three-vessel disease operated on by experienced surgeons. At this moment, we have no reason to believe graft patency will deteriorate in the future. On the basis of these results, the knowledge that arteries are to be preferred over veins for coronary bypass grafting, and the absence of a leg incision, we believe this operative technique is superior to the use of venous grafts.

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