The current status of surgery for coronary artery disease.

Surgery for coronary disease has been advocated for the past thirty five years. If the number of operations done between 1940 and 1970 were compared to a dripping faucet, then the number done in 1975 would be a deluge. By far the most frequently performed procedure is anastomosis of saphenous vein grafts from the aorta to coronary arterial branches. Internal mammary to coronary anastomosis is preferred by some highly experienced surgeons in the field. In general, the reported patency rates have been in the 90% range which is higher than most authors claim with vein grafts. On the other hand, the mammary procedure is generally considered more difficult technically and some feel that vein grafts carry higher flow. As with any new procedure there are some points of general agreement, and many points of wide disagreement. Excellent and complete reviews of the literature on this subject have been recently published.’,’ The purpose of this communication is not to repeat these scholarly works, but instead to search through the clouds, fog, haze,and smoke in hopes of gaining a glimpse of light in an effort to understand the basis of some of the agreements and disagreements. Hopefully this could provide a framework for sound analysis of current and future publications on the subject.