AW: [HSF] Percutaneous Valves

[Tea Acuff]

Sorry. You have this one backwards, but it may seem the same since you are down under.
 
Operability is the excuse. It is about new technology, market share, perception of morbidity, perhaps rigidity of those that controlled this space (ie us, we could send them out in two days sometimes if we wished, for starters), and in the end maybe even actual morbidity. Since the researchers both surgeons and cards, by design, loaded the early experience with HUGE bias by judgment, we will likely never know if it is about actual morbidity. Operability is the excuse like eliminating CAB was for DES. If you want to feel better about it think of it as OP AVR, which will be good for calcificied aortas, JW, emergent on Plavix, etc. Guess we surgeons should have gone completely (80%) OP CAB. It would at least show we are on the road.
tea


----- Original Message ----
From: Donald Ross <donross at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, February 2, 2007 2:54:38 PM
Subject: Re: AW: [HSF] Percutaneous Valves


The debate is clearly about operability.
The reason I am puzzled is that I can't remember knocking back an AVR  
and  we are referred cases from the very jaws of death
Don.
On 03/02/2007, at 4:46 AM, Michael Firstenberg wrote:

> These are not really all of that bad.... so far.... for us "open valve
> surgeons".
> I have seen several first hand and right now they really are an
> Institutional Tour de Force.  Think of it - patients "too sick for  
> AVR" (of
> course we can debate that definition).  The ones I have seen,  
> required very
> (and I mean very) skilled 1) Echocardiologists 2) CT anesthesia 3)
> Interventional Cards AND 4) an Aortic surgeon - all working  
> together.  Even
> with this group, they are still far from ready for application  
> outside of
> the meccas.  And, it is not just putting them in, but also dealing  
> with
> potential problems and co-morbidities.
>
> Besides, as we know, "knock off" a few "heathy" patients who
> could/should/would have had AVRs and someone (administration? risk
> management? legal? common sense?) will shut down this activity real  
> quick.
> These are no longer the days of Grundzig, Battista, Gibbon, etc......
>
>
> -michael
>
>
>
> On 2/2/07, Hgrmd at aol.com <Hgrmd at aol.com> wrote:
>>
>> Nand,
>> I agree.  Percutaneous AVI's are coming.  Get ready.
>> Hal
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