Coronary Artery Surgery in New York State

To the Editor. — Hannan et al 1 concluded from their study that significant risk factors for in-hospital death were age, gender, ejection fraction, previous myocardial infarction, previous open heart surgery, diabetes requiring medication (oral or insulin?), dialysis dependence, and others. Hannan et al confuse "open heart surgery"—an incision into the myocardial cavity exposing the chambers—with coronary artery bypass graft surgery, in which the epicardial surface is not penetrated. Combining coronary artery bypass graft surgery and valvular surgery obviously means longer operative, cardiopulmonary bypass, and aortic cross-clamp times with greater probability of perioperative and postoperative complications. In this era of extreme cost consciousness and with New York's serious fiscal problems, how could this research proposal requiring extensive data collection and computer time clear an institutional review board, whose reply certainly would have been, "These data have already been collected and reported in the world literature. What is original about your