[HSF] STS

[psimha]

Hal, remember when I told you about the 4 cm2 reduction in area with the 
clip and coronary sinus device !! Thats what they are talking about !!
It is funny how people actually deride people who pioneered things. I 
agree that  Carpentier has strong views of things but then he has solid 
data of years to back up what he talks. It is like making fun of Gibbon. 
he may have done just  a few open hearts with what may be said to be 
with a disastrous mortality but then would we deride him !!  I think it 
would show people in better light if they acknowledge a person's 
contribution and say that there works progresses from that - more mature !!
I think Taggarts article is there in ATS.
Prasanna 
Hgrmd at aol.com wrote:
> 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
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