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

[Edward Bender]

Mike:
I find it interesting that you do your CABG's on pump because of your  
youth.  I do them on pump due to my old age and my unwillingness to  
exit my comfort zone.  I also worry that as my tremor increases, my  
ability to do small off-pump vessels will diminish.
Ed Bender, MD

On Dec 22, 2007, at 5:28 PM, Michael Firstenberg wrote:

> I dont like hitting my thumb with a hammer when I hang a picture in  
> my home, but sometimes I need to use the tool.  CPB is one of the  
> greatest inventions to modern medicine and when I need my CPB I want  
> it done with bypass (and I want my heart arrested with antegrade and  
> retrograde when I get my AVR).  There have been countless papers  
> talking about the harmful neuro effects of CPB - and while I do not  
> have the reference, I recall the NEJM article (ok, stop laughing)  
> that said there was no different in CBP pts vs age matched controls  
> vs matched patients getting hip replacements.  As people have  
> mentioned, there are good surgeon and bad surgeons who give good and  
> bad operations, but I think at the end of the day not using bypass  
> when it should have been used has probably hurt more people than  
> using bypass.  Yes, there are micro embolic, air, alterations in  
> flow, etc - but in the long run are there longterm problems - I  
> guess if is knocks out the random part of your brain where your  
> anniversary date, children's names and birthdates, or wife's name  
> are stored.  Like any useful tool - misapplication can result in a  
> catastrophe.  I do most of my CABGs on-pump for a variety of  
> reasons, many of which are related to my youth, but I do off-pump  
> when the targets are big (which in our practice is rare) or when  
> patients need a LIMA to LAD only.  Contrary to much of the  
> "literature" by those to make their careers writing about off-pump,  
> I still find it hard to believe that the anastamosis is as good or  
> that the patients get as complete a revasc.  I have seen and grafted  
> many small OMs, diags, even LADs that would have been a pain in ass  
> to graft off-pump - I guess one could argue that those didnt need  
> grafting at all.  Furthermore, as I am sure Ani can attest to, many  
> patients have significant neuro-cognitive improvements when they get  
> more blood flow to their brains - whether this is accomplished with  
> a VAD or CABG or valvular surgery - separating this out from the  
> obvious potential harmful effects of CPB on the brain is  
> impossible......besides heart surgery is not cosmetic surgery or  
> botox injections, we are dealing with major problems and sometimes a  
> few small battles are lost to win a war.
>
> -michael
>
>
>
>
>
> On Dec 22, 2007, at 5:24 AM, Prasanna Simha M wrote:
>
>> I would like to know one thing that is physiological  wrt to  
>> cardiopulmonay
>> bypass ?
>> Prasanna
>>
>> On Dec 22, 2007 3:14 PM, <NielsB at aol.com> wrote:
>>
>>>
>>> This discussion is always interesting. I must again   one of the  
>>> many
>>> excellent quotes of my   great friend and previous partner in  
>>> Buffalo:
>>>
>>> "Why do people feel so safe when they enter an airplane? Because  
>>> the pilot
>>> goes with you, and he would probably not go if the plane was unsafe.
>>> But when the cardiac surgeons say: we are going on pump it is not  
>>> exactly
>>> true, because the surgeons does not go on pump himself, only the  
>>> patient"
>>>
>>> Of course it does not mean that the pump is   a priori bad,  
>>> sometimes we
>>> need
>>> it sometimes not, it is a tool and an important one some times.
>>>
>>> We should not be so fixed on this issue any more, but also not  
>>> ignore the
>>> issues. As the previous writer said, maybe a couple of hours on  
>>> the pump
>>> will
>>> rejuvinate the brain. Of course that is   a joke as far as we know,
>>> because I
>>> really dont find much evidence that the brain is better with than  
>>> without
>>> pump.
>>> Most sudies show that   cognitive functions etc are worse or equal  
>>> with
>>> pump
>>> not better.
>>>
>>> So maybe   most patients do not understand all this things, but as
>>> surgeons
>>> maybe it   is our responsibility to use the tool when it is  
>>> indicated and
>>> necessary, and in my opinion in CABG it is not usually required.
>>>
>>> Jacob Bergsland
>>>
>>>
>>> **************************************
>>> See AOL's top rated
>>> recipes (http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004 
>>> )
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>>
>>
>>
>> -- 
>> Prasanna Simha M
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