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

[Prasanna Simha M]

That is very true. More marketing hype than reality as we see often in
cardiac surgery and cardiology.
Prasann

On Dec 18, 2007 9:12 PM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:

> 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)<http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004%29>>
> >_______________________________________________> >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>
> -----------------------------------------
> _________________________________________________________________
> Telly addicts unite!
>
> http://www.searchgamesbox.com/tvtown.shtml_______________________________________________
> 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
> -----------------------------------------
>



-- 
Prasanna Simha M