[HSF] STS

[Mitch Lirtzman]

Here, here (or is it "hear, hear?) For my last blurb of the night...Hal has 
hit the nail on the head. Taggert wowwed 'em again, and as for Feldman, 
well...what Hal said.
And just as a bit of OT, I really enjoyed meeting, listening to and 
laughing with all those who attended the HSF/Edwards dinner on Sunday 
night. How pleasant to finally place a face with all the names. Hal, thank 
you for your very informative talk. I look forward to seeing you all again. 
MitchAt 07:11 AM 2/1/2007, you 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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