[HSF] STS

[Hgrmd at aol.com]

I got home from San Diego last night.  The STS was fairly  enlightening, 
though I didn't attend listen to as many papers as I should,  because I was really 
tied up with industry examining my ring ideas.  Last  Saturday, I attended 
George Lawrie's mitral repair course.  He has a system  that relies exclusively 
on resuspending all prolapsed segments with Goretex  chords.  He also only 
uses a fully flexible band or ring for all types of  MR.  He secures these 
prostheses with a running 2-0 Prolene.  There  exists tons of recent literature 
revealing that this is a flawed approach for MR  secondary to myopathic 
ventricles. He also has plenty of snide remarks about  Carpentier that really irritate 
me so much that I flatly told him so in front of  the whole group of surgeons.  
I've reached the point in my career where I  don't really care what guys like 
him think of me.  Disagreeing with a giant  like Carpentier is OK and a 
natural progression to our field (I now  substantially deviate from what I learned 
from Carpentier).  However, to  belittle him makes that surgeon look small and 
detracts from his  credibility.
  A guy named Taggert from Oxford gave a one hour lecture on CABG vs  PCI at 
Tech-Con.  It was quite enlightening.  He examined several  large data bases 
and came to the convincing conclusion that there is a 30%  survival benefit at 
2 years if CABG rather than PCI is used for multivessel  disease.  Try telling 
that to a patient on the table while the cardiologist  is listening!  
  There was a lot of talk about percutaneous valve procedures.   The 
transapical AVI (aortic valve insertion) looks the most promising.  Ted  Feldman 
presented his study comparing E-valve to open repair.  A "success"  is when there 
is a 2 grade improvement in the severity of MR.  In other  words, from severe 
to moderate would be considered a success.  I've never  let anyone out of the 
OR with a repair that had moderate residual MR.   Ample data exists that such 
repairs do the patient no favor.  The way this  charlatan's study is 
constructed, he would be happy to enroll a 24 yo lady with  severe MR from a flail P2, 
even though he knows that she would end up with a  likely replacment if surgery 
was required more than 18 months after deployment  of the clip.  Apparently, 
the scarring from A2 to P2 from this clip Alfieri  makes subsequent repair 
nearly impossible.  In mine and many other  competent repair surgeons hands, 
repairing surch a lesion would be essentially  curative and make her survival the 
same as the general public.  In  contrast, should she eventually require a 
mechanical prosthesis, the odds of her  living stroke free to Medicare would be 
unlikely.
Hal