[HSF] To "T" or not to "T"

[Tea Acuff]

Don,

I don't have answers for you. I do notice that you are thinking from the cost view of value.

You have an interesting situation and all I have are some silly questions.

Is there every a time instead of an indication to see the status of a patient's coronary anatomy? What if he has a strong family history? What if he has a strong personal history? What if he has had CABG 20 years ago, 10, 5? What if he planned a physically difficult and geographically remote task?

Where did you get the $4-5,000,000 to do the CAB on those couple of hundred patients? How did you justify that? When does a "test" only serve the doctor?

Do you ever see those patieints or have access to them? How does not knowing help them?

tea 


----- Original Message ----
From: Donald Ross <donross at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, December 18, 2007 3:53:40 PM
Subject: Re: [HSF] To "T" or not to "T"

Tohru,
I have  a few hundred radial T complete revascularisation patients at  
> 5 years.
The problem is finding  $100,000 to pay for the CT scans, not to  
mention my dying belly fire.
BTW my son lives in Tokyo now so expect a self invitation to visit  
your unit in the near future.
Don
On 19/12/2007, at 3:03 AM, Asai wrote:

> Don
> Thanks for reply. I would like to say "a limitation" rather than a  
> weakness.
> The ultimate goal is the least eventful long term outcome. All grafts
> staying widely patent in all cases may be just an illusion.
>
> But definitely the early postop angiogram is a great feedback and a  
> teacher
> with regard to the appropriateness of choice of target sites,  
> choice of
> conduits, arraignment, length, torsion, kinking. We can aim the  
> perfection
> of art of surgery. And the long term fate is more difficult and
> multifactorial phenomenon. I have kept my revascularization  
> strategy very
> simple. And I think I am responsible to address the mid term  
> outcome of all
> skeletonized in-situ, non-composite, but aggressive sequential  
> arterial
> OPCAB in very near future.
>
> Like Roberto mentioned, I hope you would let us know the long term  
> fate of
> LIMA-RA T graft even with MDCT and clinical event free data. You  
> know that
> we need these data to appeal to public and cardiologists and of  
> course for
> us to perform better CABG. I believe our CABG is still the best
> revascularization and will be so. Therefore we should not compromise
> strategy, although there are still a lot of unknowns.
>
> Cheers
> --
> Tohru
>
>
>
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