Two hundred ninety-eight patients who received internal mammary artery (IMA) grafts were reviewed seven to nine years after surgery; 91.6% of these patients are still alive. In 29.5% of these patients there was postoperative graft visualization, and 90% of the studies were performed because of suspected graft failure. Attrition of the IMA graft was minimal. At zero to 24 months after surgery, 93.4% of grafts were patent. At 60 to 108 months 94.4% were patent and there was little, if any, evidence of atherosclerosis in the IMAs. Precise technique in preparation and anastomosis of the IMA is essential for long-term patency. For bypassing obstructive lesions, we recommend selection of the IMA (if it has sufficient size and flow) for use in the left anterior descending, large diagonal, or marginal vessel in the left coronary artery circulation.