[HSF] the great con...... another ONvOFF debate

[Tea Acuff]

Well said, Tohru, in very lucid English by the way.

Your ideas are a reflection of the idea (model) that surgery is an interaction between surgeon and patient and the idea of the importance of which population is selected for measurement and thus results. Looking for the correct solution in general (the abstract world) is largely a flawed task or question. Or if we prefer and seemingly must talk of universal solutions and techniques such universals or guides exist only in the sense that each patient and each surgeon is of the same universe and thus equal to each other in the over riding way. In the final analysis individual results of each patient and each surgeon are more important than style (guidelines or universal solutions). And as per Ani's recognition, these same results are not typically what we mean when we tout evidence based medicine. (perhaps not so lucid English)

tea


----- Original Message ----
From: Tohru Asai <toruasai at belle.shiga-med.ac.jp>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, December 28, 2007 11:39:18 PM
Subject: Re: [HSF] the great con...... another ONvOFF debate

Contributers to this thread

I have been enjoyed the endless debate, and let me say something.

When I personally discuss about patients for CABG with John Puskas a few
years ago, he mentioned that they ( American cardiac surgeons) were still
lucky to have many patients for CABG even though emerging multivessel
stenting PCI.

I think we should take the patient group in daily practice of each of you
into consideration. At this time, on-pump CABG is equivalently as good as
"excellent" OPCAB in most countries. But let's imagine the majority of
candidates have diabetic nephropathy, untouchable aortic disease, and/or
repeated MI following multi PCI..etc. Maybe it is the future we will face.
Then this debate will be different.

You choose on or off depending on your daily patient characteristics of
majority unconsciously in addition to your achievement of technical skill
and philosophy. Are you guys ready for a possible tough future?

I used words "excellent" OPCAB, because outcomes of OPCAB can easily vary
from poor to excellent, compared to established on-pump CABG. If patients
are very sick. With huge heart or unstable hemodynamics, I know we need a
special skill, a different mind set and strategy for consistently excellent
outcome.

Many guys live in country, that have forbidden postoperative angiograms and
even MDCT. How can you control the quality of fine surgery or develop skills
with confirmation step by step. I guess it is difficult.

A hard core off-pumper
-- 
Tohru Asai


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