AW: [HSF] Percutaneous Valves

Sun Feb 4 03:41:21 EST 2007

I agree - all this talk about the surgeon getting involved in the cathlab 
amuses me. Last time I checked we were surgeons and not cardiologists or 
radiologists. I think we should keep it that way. There are no surgical 
diseases; if a disease leaves the realm of surgery (such as tuberculosis) we 
should not go chasing it and feel it is our birth right to treat it. We 
should stick to diseases and conditions that still need our (surgical) 
expertise. If CAD does (as likely will one day) leave the surgical realm 
then it no longer requires a surgeon. If a wonder drug that dissolves 
atheroma is found will we also be requesting that only we prescribe it?

There will likely always be some role for the open CT surgeon; if not the 
specialty will perish - which wont necessarily be a bad thing as that would 
be natural evolution of medicine. It would be naive to think the things we 
do now will be done in even 100 years time.

For now there will be CT surgery. For those who truly desire sticking 
needles in the groin as part of their armamentarium then there is always an 
option to retrain as a cardiologist and leave surgery. One cannot have it 
both ways. Surgery is a different skill from interventional cardiology; a 
lot of us  operate solely, and directly, with our hands through a big 
sternotomy or thoracotomy, so why do we feel that we will have the ability 
to manipulate wires in 2mm vessels? We should at least give the specialty of 
interventional cardiology some credit!

As for suggesting residents get cath based skills I find that even more 
laughable. The existing 2 to 3 year programs (in US) are barely providing 
enough training in basic CT surgery, talk less all the specialized and 
complex surgery that dominates today's practice, and we are suggesting 
trainees spend precious training time in the cath lab? Surely, the answer to 
the crisis (?) is to promote surgery and not to become cardiologists - while 
the latter may be a way of survival for the individual, it is certainly not 
one for the specialty. What next? The STS becoming a subforum of the ACC?

Discussions like this amuse me also because at the end of the day we 
(doctors) are all the same. Our disgust with PCI is because we are not doing 
it. I bet if PCI was in surgical realm there would be not much difference 
(in prevalence of PCI) - we all come from the same crop (doctors) as do 
cardiologists. After all faced with the same fee for a 4 hour operation, 5 
day hospitalization with intensive aftercare; compared to 30 minute 
procedure, no aftercare and one day in hospitalization, which would we do 
more?

Ani
  ----- Original Message ----- 
  From: Tohru Asai<mailto:toruasai at belle.shiga-med.ac.jp>
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
  Sent: Saturday, February 03, 2007 8:37 PM
  Subject: Re: AW: [HSF] Percutaneous Valves

  Nand
  At the biginning of PTCA, quite a few cardiac surgeons got involved in 
PTCA
  in Japan! ( They routinely performed preop and postop catheterization and
  even used to teach cardiologists how to do it!). Now I live in the 
country,
  where CABG to PCI ratio is almost one to 10-20. This was not due to 
Japanese
  cv surgeons' laziness for PCI involvement, but something else. Obviously,
  evidence is ours, ie CABG is better than multi PCI in severe triple 
vessel.
  But there are so many guys who simply don't care EBM, longterm outcome, or
  even anything after cath lab theater. The bottom line is that they are
  sitting in the upstream of patient flow (I think Hal pointed out).

  There is an old saying, "when a man have something he want to do, he can
  easily make up many reasons to justify it."

  What is really irritating me is their intentional ignorance of our 
practice.
  IMHO, criticism probably produce nothing. But don't worry, no matter how 
the
  surgeons get involved, we will be left out as long as their sitting in the
  upstream. We should be competent enough to receive any sicker patients, as
  long as we want to stay alive without changing our specialty to
  cardiologists. More essentially, our "strong" surgical representatives 
needs
  to get involved in guidelines creation, as David Taggart must have 
adressed.
  -- 
  Tohru Asai

  > I think,
  > instead of criticising the cardiologists, the surgeons need to be 
involved
  > in the procedure right from the beginning, so that we are not left out.
  > Nand

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