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

Sun Dec 23 14:33:14 EST 2007

Horse crud - there is probably more science in cardiac surgery than in many
other areas of medicine combined.  People just dont read it, believe it,
agree with it, or feel it applies to them or their patients - all of which
may or may not be appropriate.  Patients are individuals and the data that
comes from studying populations must be applied on a singular basis.
However, much like the Heisenberg (sp?) Uncertainty Principle - the most be
start to apply science and make a decision, we realize how little we know
hence with must draw on experience, the literature, and science (and of
course a lot of luck and voodoo).

-michael

On 12/23/07, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
> > > I think your excellent comments on the scientific merits of cardiac
> surgery> fall on deaf ears (I hope the deafness is reversible).
>
> Ajit
>
> Thanks for your comments. Yes I find this 'surgical deafness' is often the
> case in many issues we debate on the forum. Once it comes to scientific or
> epidemiologic rationale or logic there is often an inability of us as
> surgeons to see things objectively. Mind you a lot of the comments I make on
> HSF are not necessarily my personal views (for example, I actually believe
> OPCAB to be a superior technique), however one has to keep his own views and
> biases out of making a rational assessment. I remember once I put forward a
> view at a meeting that there was no evidence that a vein was inferior to the
> LIMA on the LAD (of course I do not believe that) and everyone looked at me
> as if I was drunk - of course none of them have ever read loop's paper but
> if they had they would realize how weak the evidence on which we base our
> practice is. Often I find myself and the views I take ending up with the
> minority, but that is a position I am comfortable with as I would rather
> that than be with the majority (as change will come from unconventional
> views). If everyone agreed with what I said then it means I have to think
> harder. The recent debates over aprotinin or regarding chest reopening
> highlights a lot how illogical or irrational we are in our thinking and
> assessment.
>
> I learn a lot about surgical technique and management on this forum which
> is invaluable, but I also learn a lot about surgical behaviour, thought
> processes and analysis - a lot of which leaves me perplexed. But I suppose
> one essence of being a surgeon is that one has to belief in one's self -
> unfortunately it often comes with the package that in doing that we tend to
> disbelief all other.
>
>
>
> Ani
>
>
>
> > From: damle at cableone.net> To: OpenHeart-L at lists.hsforum.com> Subject:
> RE: [HSF] "Patients don't want cardiopulmonary bypass" - the great con>
> Date: Sat, 22 Dec 2007 10:53:26 -0600> CC: > > Ani,> > > > See the recent
> paper in the December Annals: " Neurocognitive Outcomes 3> Years After
> Coronary Artery Bypass Graft Surgery: A Controlled Study".> > > > I think
> your excellent comments on the scientific merits of cardiac surgery> fall on
> deaf ears (I hope the deafness is reversible). I have been following> the
> HSF forum since its inception. It is my experience that this is a great>
> forum for practical advice and sharing surgical techniques. Strangely>
> though, our minds are impervious to scientific thoughts, particularly when>
> they involve statistics. > > > > Still, I do hope you continue your
> intelligent and balanced commentaries on> this forum. I am glad to see that
> you will be teaching at the post-graduate> forum at AATS. > > > > Ajit
> Damle> > > > > > -----Original Message-----> From:
> openheart-l-bounces at lists.hsforum.com> [mailto:
> openheart-l-bounces at lists.hsforum.com] On Behalf Of Ani Anyanwu> Sent:
> Saturday, December 22, 2007 9:00 AM> To: openheart-l at lists.hsforum.com>
> Subject: RE: [HSF] "Patients don't want cardiopulmonary bypass" - the great>
> con> > > > And having your heart lifted out of the chest beating upside down
> is> physiological? The sometimes promoted notion that off-pump surgery is>
> physiological is part of the great con - I would like to know one thing>
> about general anesthesia, or being operated upon that is physiological. Let>
> us not pretend there is anything normal about having one's heart operated>
> upon - which ever way you dress it heart surgery is a big insult to the>
> body.> > > > Again I say there may be benefits to avoiding CPB but let us
> not pretend the> patient's desire is what is driving this.> > > > In
> response to comments on Dr Sergeant's excellent results - I put it to you>
> that if he were to adopt his entire system and change only one thing -
> start> using CPB - his results would be exactly the same. His results are a
> marker> of good surgery, sub-specialization (my understanding is that his
> practice> is almost entirely CABG), and good systems management and not
> off-pump> surgery.> > > > Ani> > > > > > > > > Date: Sat, 22 Dec 2007
> 15:54:30 +0530> From: prasannasimha at gmail.com> To:>
> OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] "Patients don't want>
> cardiopulmonary bypass" - the great con> CC: > > 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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