This study presents the preliminary results of systematic revascularisation of the left anterior descending (LAD) by the internal mammary (IM) artery. Between 1981 and 1983, 200 IM bypass procedures were performed (88.5% of bypassed LAD arteries during the same period). With experience, the contraindications of IM bypass surgery progressively decreased (none in the latter 100 cases). The IM bypass grafting was an isolated procedure in 35% of cases and associated with one or more saphenous vein (SV) bypass grafts in 64.5% of cases with an average of 1.9 grafts per patient. The surgical results were better than those of SV bypass grafting alone in the period 1978-1980 with a mortality of 2.5% and a perioperative infarction rate of 2.5% compared to 4.3% and 7% respectively. The medium term results (average follow up 2.5 years) show that more patients undergoing IM bypass surgery were asymptomatic (75%) than those undergoing SV bypass (46%). However, the patients operated more recently by IM bypass benefitted from the latest technical advances in bypass surgery. An unselected sample of 55 volunteers (out of 90 recalled patients) underwent angiography at 1 year. The patency rate was 93% with a very satisfactory angiographic appearance of the graft in nearly all patients suggesting the likelihood of a good long term result. It was possible to demonstrate graft patency by Doppler ultrasound and digitised intravenous angiography in some cases.(ABSTRACT TRUNCATED AT 250 WORDS)