myocardial revascularization of the anterior descending coronary artery with left internal mammary artery by means of extracorporeal circulation 10 years followup background the use of left internal mammary artery lima as a graft to anterior descending artery lad has been associated with better long term results in coronary surgeryaim to assess and report the longterm results of lima to lad bypass grafting for isolated lda lesionspatients and methods retrospective analysis of the medical records and surgical protocols of 40 patients aged 6010 years 28 male subjected to coronary surgery between 1992 and 2002results thirtyfour patients presented with unstable angina on angiography the lad had a proximal obstruction in 35 patients sixteen presented with a myocardial infarction of the lad territory six were managed previously with angioplasty four had a new critical obstruction 1 was catalogued as a procedure failure and one was totally occluded there was no operative mortality myocardial infarction stroke or need for re operation there were two late deaths caused by an advanced cardiac failure at 120 months in one patient and chronic renal failure at 61 months of followup in another actuarial survival probability was 100 93 and 75 at 1 5 and 10 years probability of freedom from angina was 98 and freedom of suffering a new myocardial infarction was 100 at more than 10 years the probability of no need for a new coronary procedure angioplasty or surgery also was 100 at more than 10 yearsconclusions the use of lima as a coronary bypass graft to lad is a safe surgical technique with an excellent duration and permeability and also provides a prolonged time free from cardiac events as mortality angina myocardial infarction and the need of a new coronary procedure