Institutional variation of coronary artery bypass graft surgery: emphasis on myocardial protection.

Abstract

There are institutional variations in the operative mortality of coronary artery bypass graft surgery (CABG). Patient selection, based on clinical and angiographic criteria, is a significant factor. Even after adjustment for patient selection, institutional differences remain. Operative experience and volume of cases are also related to institutional variations. Recent attention to the technique of myocardial preservation has highlighted its significance in reducing the incidence of perioperative myocardial infarction and operative mortality. Institutional heterogeneity also exists in the nonoperative management of ischemic heart disease. However, undetected factors probably significantly affect the outcome. These institutional variations emphasize a major advantage of randomized clinical trials--that they should equalize these unknown factors.