Risk modification in open heart surgery Our clinical research has recently emphasized an examination of the means of decreasing the risk of open heart surgery, and innovating ways to permit open heart surgery in previously inoperable patients. Risk-lowering efforts have emphasized a multimodality approach to blood conservation, a retrospective and prospective analysis of the risks and exploration of methods of risk modification for stroke and neurologic events in open heart surgery, and the investigation of pharmacologic manipulations designed to treat myocardial failure following open heart surgery. These strategies have included new applications of the drugs aprotinin and erythropoietin for blood conservation, an investigation of doppler analysis and blood pressure modification to assess and reduce stroke rates during cardiopulmonary bypass, and the use of triiouothyronine and milrinone as inotropes in cardiac surgery. These efforts have incorporated a multidisciplinary approach to clinical research and have been funded by a number of outside agencies. These efforts represent a continuation of previous clinical research efforts, including participation in the Coronary Artery Surgery (CAS) study, and participation in a number of studies examining the safety and efficacy of valve prostheses. A multidisciplinary cost containment program has been developed to provide expeditious and efficient peri-operative care in response to the current changing health care climate. Finally, we are sponsoring basic research in the areas of gene therapy and angiogenesis in order to develop a biologic approach to revascularization. In these studies, we hope to further define the pathophysiology of atherosclerosis and collateral vessel formation, and develop means of accelerating tissue reperfusion related to these processes.