AW: [HSF] Percutaneous Valves

[Nasser F. Abou'Seada]

Very Well said Ani. I do totally concur with you. 

NFA
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of Ani Anyanwu
> Sent: Sunday, February 04, 2007 3:41 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: AW: [HSF] Percutaneous Valves
> 
> 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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