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

[don ross]

Michael,
I have to rise to the bait after reading, yet again, the on going OP/ 
ONCAB debate.
There is nothing wrong with CPB or arrested hearts.
However clamping 1000 aortas will result in 15-20 strokes half of  
which will die not to mention the grams of brain that will randomly  
infarct "without clinical consequence"
The extra effort to learn safe opcab is therefore well spent if you  
want eliminate the last few percentages of cabg morbidity.
You shouldn't care how WFMC or CCF do their coronary surgery if you  
can do it better.
Don
On 26/12/2007, at 5:50 AM, Michael Firstenberg wrote:

> 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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