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

Ben Bidstrup benjamin.bidstrup at bigpond.com
Mon Dec 24 09:37:29 EST 2007 

Applying population statistics to an individual is the art of 
medicine (cardiac surgery) and all the other things you mention. As 
we have discussed ad nauseam a patient cannot be 1.24% dead. Just 
SOOL if they happen to be one of the 1.24%.



>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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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon

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