[HSF] Too scared to touch.....
Donald Ross
donross at bigpond.com
Fri May 4 09:09:34 EDT 2007
Good grief, Ani, surely your patients are safer in hospital than on a
waiting list! ......Even a Canadian one.
Don
On 03/05/2007, at 7:28 PM, Ani Anyanwu wrote:
> This is not necessarily the case that patients will be alive if
> they had been kept in hospital though.
>
> 1) Patients also die as inpatients while awaiting surgical
> referral, consultation or operation. Being in hospital does not
> save you from sudden death unless you are at right place at right
> time (e.g. empty operating room available in daytime). Sudden
> cardiac death remains a major cause of mortality in CCU and
> cardiology wards, and when it happens is often irretrievable
> despite being in hospital.
>
> 2) Patients die during and after surgery. How do we know that
> patients who are at risk of sudden death are not also at risk of
> peri-operative death, or early or medium term death? I am sure most
> would have seen a few over the year die on induction of anesthesia,
> albeit a rare occurrence these days I agree.
>
> Cardiovascular disease remains, and will remain for a while, the
> leading cause of death in Western Adults - I think it is simplistic
> to believe that any tertiary intervention, that does not include
> prevention or *cure* of disease (including if we are all
> hospitalized) will change that.
>
> Ani
> ----- Original Message -----
> From: Donald Ross<mailto:donross at bigpond.com>
> To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-
> L at lists.hsforum.com>
> Sent: Thursday, May 03, 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<mailto: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<mailto:donross at bigpond.com>
>>>>> To: OpenHeart-L at lists.hsforum.com<mailto: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<mailto: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
>>>>>>>>
>>>>>>>>
>>>>>>>> ************************************** See what's free at
>>>>>>>> http://>>> www.aol.com<http://www.aol.com/>.
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