[HSF] (More) stupid lines of evidence

[Tea Acuff]

One of the nice things about our new heart hospital is that I get to hear the second hand stories of how other surgeons handle (or fail to handle) situations. 
 
There was this description from the manpower view of the scrub nurses of a day when all the cases were "long and difficult". One of the on pump surgeons was finishing a case, closing, when things went to hell and he needed to crash back on bypass to redo the LAD graft. It was the usual fire drill that shows the surgeon's type of management skills. That started me thinking. Imagine. I never(?) crash back on bypass to redo coronaries as I rarely do them on pump to start with. But what is an on pump surgeon to do? What else CAN on on pump surgeon do? What does a facile off pump surgeon do?
 
I remember the (crap) data, well popularized and from my "group", that when off pump surgeons have to crash on pump their results are inferior. So? How is that compared to on pump surgeons? What does their crashed on data look like compared to all off pump, all on pump, or even crashed off pump?
 
None of this proves or shows which way to do an operation, except that a surgeon should try to do it competently if one can. Unfortunately this type of imagination evidence is Class C (or less) data. (Except for that paper I mentioned that showed that treatment of heart failure by the guidelines is Class A evidence.)
 
tea