[HSF] The Great con....

[Tea Acuff]

It is nice to hear from everyone, Cary. I don't actually believe the world is flat despite the now popular metaphor. 

I have thought for myself about the dilemna that your partner faced. I came to the conclusion that although I prefer English, I would request that the surgeon speak in his common if not his best language (veins and all). I am very uncomfortable asking for the specially prepared but seldom cooked meal. At least if I am to be the meal!

As an aside and in a wrinkle that we seldom discuss concerning informed consent, as an overly informed patient (if it is CAB), I would have NO request except that the surgeon take care of me if I agreed roughly with his intent.

Your story reminds me of the different in appearance but similar in conclusion old riddle. In a two barber town do you go to the barber with neatly cut hair but a messy shop, or the barber with a neat shop but messy hair? Its not what you look like, but what you do.

tea


----- Original Message ----
From: "CSPassik at aol.com" <CSPassik at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, December 30, 2007 12:07:35 PM
Subject: Re: [HSF] The Great con....

As this ongoing debate has started to take on the dimensions of how many 
angels can you fit on the head of a pin,  I would like to weigh in with a little 
science and a little anecdote-which is of course the essence of surgery, isn't 
it? One of my partners is, IMHO,  a superb OPCAB surgeon.  We have an 
office based  computer database dating back to 1980 so it is easy to pull up data. 
  As he was always touting the superiority of OPCAB at meetings,  I decided 
to check on everything we tracked between his OPCAB's and my ONCAB's( I am 
mostly an ONCAB guy) There were about 500 OPCABS over about 4 years and 350 
ONCAB's over about 3 years or so. Basically, in this real world, non-published 
study there was no difference between the two groups.  LOS, blood loss, number of 
grafts, mortality, even stroke  were better on-pump than off. OPCABs 
occassionally get strokes even with heart strings  with transient hypotension. 
Many(but not all)strokes ONCAB can be avoided with single cross clamp, creative 
cannulation, odd ball proximals, cute cannulas. The only thing worse about 
ONCAB's were percent pressors coming out of the OR- 30% vs. 20% and the incidence of 
transient renal dysfunction 4% vs. 3%. I didn't do any statistical 
evaluations beyond that.During the same three year period, there was one patient 
(dialysis patient with a calcified aorta down to about 3 cm above the aortic valve) 
that i didn't think could safely be done On pump so we did it together. The key 
is to recognize that patient.  And now, for the anecdote.  2 months ago, 
this same partner had to have an urgent PTCA of his mid-LAD.  Knowing full well 
that I  am an ONCAB guy, he asked me to be around in case he needed surgery! 
He had a bare metal stent, with excellent result, by the way  So there, it's 
settled, two very good techniques with near equivalence in results.  I 
frankly think we should be turning our sights on these ridiculous drug treated 
stents that  no matter what the manufacturer's and cardiologists say  seem to be 
a real world disaster.
Cary Passik


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