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

Thu May 3 08:06:15 EDT 2007

Don,
  I'd also bet that the authors of that paper would have the resources and the connections to go to the head of the line if they, or one of their loved ones, had LM disease.
Hal 

-----Original Message-----
From: donross at bigpond.com
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 3 May 2007 12:22 AM
Subject: Re: [HSF] Too scared to touch.....

My point had nothing to do with resources. 
It just illustrates that severe coronary disease kills at any time. 
When we had waiting lists we kept a record on cardiac deaths and they did occur and most were not LMD. 
MY POINT IS: that all these patients would be alive if they had had in house surgery despite what some Canadian study purports to say. 
Incidentally, I bet the Canadian study was funded by the mean government which doesn't want to fund it's heath care appropriately. 
Don. 
> Don - so the spa hospital has 60 % left main and emergent TVD"s - > you missed the point !!! 
> Yes - you yourself are making a point with the statement 
> "Do you really believe all Bojan's waiting list deaths had critical > LM disease?" 
> So - Do you think all waiting list deaths are left main disease - > slightly rephrased and now does it appear the same ? Then that > argument for left main itself becomes more tenuous !! 
> I am not saying that left mains should all be operated when > armegaddon comes but the reflex "in house" rush for surgery is more > of a creation than a real necessity He can be operated at an early > elective slot and doesn't really have to be rushed from the cath > lab to the OR. 
> Prasanna 
> 
> Donald Ross wrote: 
>> Prasanna, 
>> Indeed, a lot of what we practice will be found to be imperfect , >> but a lot of the so called evidence based practice is also bullshit. 
>> Do you really believe all Bojan's waiting list deaths had critical >> LM disease? 
>> Remember the bikini and statistics? 
>> Don 
>> 
>> PS It is great to have Hal onside for a change! 
>> 
>> On 02/05/2007, at 9:20 PM, psimha wrote: 
>> 
>>> Hal, 
>>> Please read carefully, In never said anything about critical left >>> mains. 
>>> Also if you carefully see what I said I said where is the >>> evidence . Some things that we practice need not necessarily be >>> right. 
>>> 
>>> Prasanna 
>>> hgrmd at aol.com wrote: 
>>>> Don, 
>>>> I agree with you. If Prasanna wants to send out critical LM's >>>> or LAD's hanging by a hair after an MI, that's his business. >>>> Around here, if such patient went home without surgery and >>>> boxed, we'd definitely hear about it. 
>>>> Hal -----Original Message----- 
>>>> From: donross at bigpond.com 
>>>> To: OpenHeart-L at lists.hsforum.com 
>>>> Sent: Wed, 2 May 2007 4:40 AM 
>>>> Subject: Re: [HSF] Too scared to touch..... 
>>>> 
>>>> 
>>>> When they have LM or TVD + poor LV....... most of my patients. I >>>> hope, therefore, you are not trying to put me out of a job? Don >>>> On 02/05/2007, at 10:53 AM, prasannasimha wrote: 
>>>>> Where in literature has it been shown that a patient who is >>>>> stable > after an MI benefits from urgent in house >>>>> revascularization ? Prasanna 
>>>>> Donald Ross wrote: 
>>>>>> Also, one wonders about the not infrequent peri-op AMIs during >>>>>> non->> cardiac surgery that come our way for revascularisation >>>>>> prior to >> discharge. Is this unnecessary surgery as well, >>>>>> given it carries the same >> indications as regular coronary >>>>>> surgery? Don On 01/05/2007, at 10:04 PM, Hgrmd at aol.com wrote: 
>>>>>> 
>>>>>>> Ajit, I invested the time it took to read all of Prasanna's >>>>>>> >>> abstracts. I'm still not convinced that medical therapy >>>>>>> with beta-blockers is >>> the way to go for nearly every >>>>>>> case. Again, if a stress test in an asymptomatic >>> patient >>>>>>> shows a lot of myocardium with reversible ischemia, it would >>>>>>> be >>> potentially foolhardy not to cath that patient. Over >>>>>>> the years, we've been >>> referred lots of patients with left >>>>>>> mains or critical 3vd that were cathed prior >>> to an >>>>>>> elective noncardiac procedure (usually carotid, ischemic leg, >>>>>>> or AAA). >>> We did the CABG, they eventually got the >>>>>>> vascular procedure, and they did >>> fine. I've yet to recall >>>>>>> "graft closure" while the subsequent case was done. In >>> >>>>>>> light of the problems with DES, the cardiologists are much >>>>>>> more likely to use >>> bare metal stents in such scenarios. I >>>>>>> do agree that beta blockade, possible Swan, and a competent >>>>>>> >>> cardiac anesthesiologist suffice for the vast majority of >>>>>>> cardiac >>> patients getting noncardiac surgery. However, >>>>>>> there are plenty of asymptomatic >>> cardiac time bombs >>>>>>> waiting to explode for those that never cath and treat >>> >>>>>>> preemptively. Hal 
>>>>>>> 
>>>>>>> 
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