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

[Michael Firstenberg]

I think there is a huge "comfort zone issue" combined with "giving patients
the best operation".  In training I did a lot of OPCABG and got pretty good
at them and they clearly take less time.  But, I also noticed in my hands
(and in my institution and with my patient population) that I did not think
the results were any better.  Do I think that it is a bad operation - no, I
just dont like it - I dont agree with the literature (as it applies in my
situation) and I have a firm believer in CPB and good myocardial
protection.  I dont think the anastamosis are as good (either in general or
in my hands - contrary to the literature and the handful of OPCAB hybrids
where I make them shoot the graft - all have been open or the patients who
have had problem and got re-cathed with few grafts being down - and those
not entirely unexpected.

There are several major meccas (i.e. The Mayo and CCF) who perform very very
few OPCAB - and one must ask why???  Are "they" inferior surgeons?  lazy?
afraid of new technology/techniques?  Maybe the just dont believe that it is
good in "every case" or should be widely applied.  Having asked some of the
coronary surgery "mavens" the arguments are the same - they dont believe it
is as good as an operation.

I am sure there is a lot of psychology behind all of this and it probably
reflects an issue of views on CPB - some either view it easier as a friend
while so as a foe.

-michael

happy holidays to all




On 12/25/07, wftjrtyler at aol.com <wftjrtyler at aol.com> wrote:
>
>
> In a message dated 12/23/2007 11:57:46 P.M. Central Standard Time,
> prasannasimha at gmail.com writes:
>
> These  surgeries (Mitral valve repairs and OPCAB) are an "exercise in
> patience". I  have seen consistently that the "fastest" surgeons are the
> ones
> who cannot  or will not do OPCAB and many a time think it is due to simple
> lack of  patience which becomes their biggest enemy. After training in
> a  fill
>
>
>
> Excellent post,Prasanna.  I would also add "perserverance" as
> the  learning
> curve for some of us is (was?) steep.    bill  turner
>
>
>
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