Refinements in coronary artery surgery contributing to improved survival.

Reviews of the literature and controlled studies of medical versus surgical treatment of coronary artery disease that include surgical results from 3 or 4 years ago may not be pertinent to therapeutic decisions made today. The results in our patients operated during 2 two-year periods (1974--1976, Group I and 1976--1978, Group II) are compared. The Group II patients had more severe coronary artery disease. They had significantly more grafts per patient (p less than .001), their cardiopulmonary bypass time was significantly reduced (p less than .001), they received less inotropic support (p less than .005) and spent less time in the intensive care unit (p less than .001). There was a significant decrease in the overall perioperative mortality (30-day) in the patients of Group II (p less than .055). The second two-year period coincided with the adoption of refinements in the intraoperative preservation of myocardium and also in surgical technique. These refinements are discussed in detail.