[HSF] Too scared to touch.....

[Ben Bidstrup]

As Hal will no doubt state, in private practice it is the 
oculo-cardiac reflex that applies to LMS. If we say no, then they 
will get sent somewhere else.

Even longer than 15 years ago in the UK, the same applied. I recall 
one very eminent surgeon who insisted on repeat angios if the 
original one was older than 12 months. There were a lot of them.

>Just to spice  the discussion , an anecdote from Croatia:
>a private hospital , but contracted to the state insurance (therefore
>motivated to do as many cases as possible) persistently declares ( on
>the web) for years   a very large share ( up to 60%) of emergent CABGs,
>vast amount of them are left mains or tripple vessel  disease , unstable
>, of course. It is little odd , because it is located  in a spa in a
>rural area , far far away from  big ( city-based) CCUs. In the other
>hand , all of us  in state hospitals ( city-based , close  to CCUs)
>have the emergent  CABG rate well below 10 % , as left main patients ,
>unless unstable , wait  for long time . I am telling that  just to show
>that  practices  may be  driven not only by medical , but also by
>paramedical  parameters( not  necessarily financial , but habitual ,
>availability related , etc.etc.).My UK experience  from 15 y  ago is the
>same  as Ani's.
>Bojan
>
>On 5/2/2007, "psimha" <prasannasimha at gmail.com> wrote:
>
>>There is no evidence base for stable left main. Only for unstable left
>>main to be specific.(The Canadian study some years back seemed to
>>expound it elegantly)
>>Prasanna
>>Ani Anyanwu wrote:
>>>  What is the evidence base for emergent revasularization of Left 
>>>Main? When I worked in England few years back we had patients with 
>>>Left Main on the waiting list for surgery for as long as a year.
>>>
>>>  ANi
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon