Much progress has been made in the treatment of cardiovascular diseases in the last decade. However, heart disease remains the principal cause of death in the United States (328 persons per 100 000 annually).
A continued and rapid evolution in the treatment of patients with ischemic heart disease has affected the practice of cardiothoracic surgery substantially. It is estimated that 85 000 percutaneous transluminal coronary angioplasty (PTCA) procedures were performed in this country in 1984 and a greater number in 1985. Whereas, in the initial stages of the development of this procedure, single-vessel disease was the most common indication, it is now being performed in some centers on patients with double- and triple-vessel disease. The impact of PTCA on the numbers of patients being referred for coronary bypass operations is becoming noticeable, and the role of the surgeon in the treatment of these patients is not yet clear. There is