AW: [HSF] Percutaneous Valves
Ani Anyanwu
anianyanwu at hotmail.com
Mon Feb 5 00:12:44 EST 2007
Dear Dr Gammie
Then why do we also not prescribe furosemide and lisinopril to treat the
majority of patients who do have valvular heart disease? Why do we not also
undertake investigation and long-term care of these patients? Most
structural heart disease is actually treated by cardiologists and not by
surgeons.
Is it not a mark of a struggling specialty if we are now seeking to claim
what we never claimed in the past. We were never interested in PCI till
recently when our numbers started going down and now we all believe we
should treat all coronary disease? Same is happening with valvular disease.
I do understand where you are coming from and agree with you 100% that we
have to reinvent ourselves but why cant we reinvent ourselves first by doing
what we are supposed to be doing (well) before seeking to do what others are
doing? If, for example, majority of patients in the USA are still getting
saphenous vein grafts for CAD and mitral replacement for MR do we really
have the standing as a specialty to claim we treat heart disease the best?
Little wonder others(cardiologists, basic scientists etc) look for better
solutions. I think the greatest threat to our specialty is ourselves and not
any outside specialty.
Ani Anyanwu
----- Original Message -----
From: James S Gammie<mailto:gammie at comcast.net>
To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
Sent: Sunday, February 04, 2007 10:25 PM
Subject: Re: AW: [HSF] Percutaneous Valves
Ani:
I respectfully disagree with you.
We are physicians who treat structural heart disease, not surgeons who do
open heart operations.
Our speciality will remain busy and vibrant if we remember this.
No physician is better suited to treat (eg heart valve disease) than we
are.
jsg
----- Original Message -----
From: "Ani Anyanwu"
<anianyanwu at hotmail.com<mailto:anianyanwu at hotmail.com>>
To: <OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>>
Sent: Sunday, February 04, 2007 3:41 AM
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<mailto:toruasai at belle.shiga-med.ac.jp>>
> To:
OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com<mailto: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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