[HSF] "Patients don't want cardiopulmonary bypass" - the great con

[Ani Anyanwu]

Giuseppe
 
The notion that patients will not have a procedure because it is "hard to convince them to go on pump" is one of the most promoted fallacies in our profession today. This is largely an invention of cardiologists and proponents of off-pump surgery. This is similar to the myth that patients will not agree to post-op angiography whereas in Japan the majority get it as we have heard. How many patients actually have a clue what CPB is? How many patients (or cardiologists) have you encountered who refused to have (or refer patients for) an aortic valve replacement or heart transplant or Fallot correction because they did not want to go on pump? All of a sudden CPB does not matter! That patients all have desire to avoid bypass is an invention of cardiologists and off-pump proponents and hype and media - patients do not know what it is or why they are avoiding it (even most cardiologists don't). I once ran a trial of OPCAB vs conventional CAB and in getting consent most patients had no clue what exactly they were being talked to about most couldn't understand how you were suggesting you would do a (coronary) bypass without (cardiopulmonary) bypass. The problem is that avoidance of CPB is being mispresented as an essential surgical advance. If the converse was the case that heart surgery had been done for years off-pump and suddenly the pump was discovered as this new high tech tool then everybody would want to go on pump (indeed that was the case in 1950s). 
 
If you talk to patients in chronic A Fib I am sure many of them would 'risk' the pump to get rid of the A Fib. It is sad that we as surgeons are adding to the disbelief in the benefit of what we have to offer by also considering CPB a drastic measure to take to cure this disease. What is wrong with 40 minutes of CPB if it will increase the efficacy of cure from say 40 to 80%? By making this assumption that patients don't want CPB we are excluding thousands of patients from a potentially curative therapy.
 
Indeed in early 2005 we had a patient from Florida who was tired of lifestyle restrictions from taking coumadin for A fib. We did not offer mini-A Fib surgery at the time. He said do whatever you have to do but I dont want to be in A Fib - he had a full sternotomy, cardiopulmonary and biatrial cryomaze. I must confess that even I thought this was excessive at the time, but he visited us 6 months ago still in sinus rhythm and said he had never made a better decision in his life...Goes to show we as doctors should not make assumptions on what we believe patients will and will not do. Having listened to Hal's talk, if I had chronic A Fib today I would not mess around with all the mini-invasive off-pump industry driven cons around (many of which as you say are only a marginal improvement on the catheter).  I would go knocking on Hals door - a 2cm incision and no Afib - who cares about the pump?
 
Mind you I am all for favour of off-pump surgery, but let us not pretend that the patients are the ones who want it.
 
Ani



> Date: Tue, 18 Dec 2007 06:06:32 -0800> From: grescigno at mac.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Robotic Cryomaze> CC: > > What I took home from Leipzig about Afib surgery (waiting for the DVD containing all the meeting) is that minimally invasive beating heart procedures have the same results (70% for paroxysmal, 30% for continuous) than the transvenous procedures. I appreciated Hal's technique because even with a minimally invasive approach it may reach higher rates of success (cryo + isthmus lesion etc.). Of course it is hard to convince a patient (and a cardiologist) to be operated on pump just for a lone afib. I have seen a few patients treated in Leipzig during my stay last year that had a long history of transvenous failures and subsequently operated on by Fred Mohr. > > Giuseppe> > Giuseppe Rescigno M.D.> Cardiothoracic Surgeon> > Lancisi Hospital> Torrette - Ancona> Italy> > > > On Tuesday, December 18, 2007, at 01:35PM, <Hgrmd at aol.com> wrote:> >Bill,> > Yes, I've done 9 robotic cryomazes, 2 as standalones. > > > >Hal> >> >> >> >**************************************See AOL's top rated recipes > >(http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)> >_______________________________________________> >OpenHeart-L mailing list> >> >Send postings to:> > OpenHeart-L at lists.hsforum.com> >> >To UNSUBSCRIBE, to CHANGE email address, or to view archives:> >http://mmp.cjp.com/mailman/listinfo/openheart-l> >> >All messages transmitted by the OpenHeart-L are subject to the policies and > >disclaimers posted at:> >http://www.hsforum.com/listdisclaim> >-----------------------------------------> >> >> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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