SD closures and Re: [HSF] Mitral Valve
murtaza chishti
cmurtaza at hotmail.com
Sat May 5 03:23:25 EDT 2007
ani can always be depended on to call a spade a spade
the whole issue of accuracy in data collection , interpretation and
reporting is a complex one. the motivations to fudge it are myriad.
deliberate doctoring, even outright fabrication, is, unfortunately , real.
' truth ' is often the casualty of the way human mind can fool itself
without knowing it. bad stuff will make its way into prestigious
publications despite the best efforts of reviewers and editors. the reader
needs to use a healthy dose of skepticism..... like ani and dr bachet
murtaza chishti
>From: "Jean BACHET" <jean.bachet at imm.fr>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: <OpenHeart-L at lists.hsforum.com>
>Subject: SD closures and Re: [HSF] Mitral Valve
>Date: Fri, 4 May 2007 14:31:24 +0200
>
>Dear ani,
>
>any surgeon normally active, experienced and sensible, must fully agree
>with your comments. When I read the abstract about minimally invasive
>mitral surgery and that "5cm" thoracotomy , I had exactly your reaction. Do
>they think we are stupid? or ignorant? I dared not to write any comment as
>I did not want to be considered as an "ugly French moralist" once again.
>You did the job and did it perfectly. BRAVO.
>By the way, I notice that the authors state that, in addition to the
>mitral repair, they have performed 69 tricuspid repairs, 201 ASD closures
>and 156 Maze procedures. This implies the opening of the right atrium. I
>would be very curious to see (and to be taught, if possible) how they
>cannulate, snare and control the venae cavae, open the RA and do the job
>through their tiny incision (which represents 2 thirds of a regular
>cigarette length!!!)
>
>It reminds me the famous reply made by Jean Hagen (playing a Hollywood
>movie star of the thirties) when discussing her contract with the producer
>in the very famous musical " Singing in the rain " by Stanley Donen and
>Gene Kelly.
>" What do you think I am: a dumb, or something??".
>
>
>Jean Bachet.
>
>----- Original Message -----
>From: "Ani Anyanwu" <anianyanwu at hotmail.com>
>To: <OpenHeart-L at lists.hsforum.com>
>Sent: Friday, May 04, 2007 11:55 AM
>Subject: Re: [HSF] Mitral Valve
>
>
>It always intrigues me how people get away with misrepresenting data.
>Surgeons particularly have a thing about exaggerating size or lack of size.
>
>Now tell me how can all mitrals be done through a 5 cm incision? To say so
>means this group measured all skin incisions and they were all 5 cm. Highly
>unlikely. All humans are different and it is impossible that the same
>operation, indeed any operation, is carried out in every individual with
>same sized incision. Even more interesting is that a 5 cm incision spreads
>to a diameter of approximately 3cm, hardly enough to even introduce a large
>valve prosthesis.
>
>This year we have reoperated on 3 patients who had early failure of
>mini-invasive mitrals (one at a reputable center). I measured all the
>thoracotomy scars and the smallest was 13cm. One of the patients even
>believes she had a robotic mitral. I have one good picture which shows that
>our reoperative sternotomy scar was shorter in length than the right
>thoracotomy scar.
>
>Selling thoracotomy mitrals as minimally invasive is one of the greatest
>scandals of current day cardiac surgery. While there are some who do a
>truly minimally invasive approach (small incision, non-rib spreading,
>endoscopes, robots etc), many just do a thoracotomy and sell it as
>minimally invasive.
>
>As for 5cm incision in ALL patients, all sizes, all body habitus, all
>pathologies? Do they think we are stupid? Anyone who says they do this
>should show me the data - measure all skin incisions and in the paper I
>want to see the median and interquartile range for scar length. You will be
>surprised what you see and I suspect most of these 5cm incisions were
>closer to 10 or even 15 cm than to 5 cm.
>
>Ani
> ----- Original Message -----
> From: Ajit Damle<mailto:damle at cableone.net>
> To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> Sent: Tuesday, May 01, 2007 4:08 AM
> Subject: [HSF] Mitral Valve
>
>
> For your comments, gentlemen.
>
>
>
> Ajit Damle
>
>
>
>
>
>
>
> ULTRA MINIMALLY INVASIVE MITRAL VALVE SURGERY WITHOUT AORTIC CROSS CLAMP
>
> Authors: Kumar, S.; Ahmad, R.; Greelish, J.; Petracek, M.; Balaguer, J.;
>Byrne, J. Source: ANZ Journal of Surgery, Volume 77, Supplement 1, May
>2007, pp. A8-A8(1) Publisher: Blackwell Publishing
>
>
>
> Abstract:
>
>
>
> Objective 
>
>
>
> We developed a technique for mitral valve surgery through an ultra small
>(5 cm) right lateral thoracotomy without aortic cross clamp. This study
>reports our combined ST. Thomas and Vanderbilt Heart Institutes five years
>experience with this technique.
>
>  
>
> Methods
>
>
>
> Six hundred and twenty five (316 M /309 F; aged 22-75 mean of 62 years)
>underwent ultra minimally invasive mitral valve surgery between August 2000
>and June 2006. Through a 5 centimeter right lateral thoracotomy along the
>4th intercostal space access to the pericardium and the left atrium was
>gained. Cardiopulmonary bypass was instituted through femoral cannulation.
>Under cold fibrillatory arrest (28°C) without aortic cross clamp, mitral
>valve repair (n = 196) or replacement (n = 380), in addition to
>mitral valve procedure we performed tricuspid valve repair (n = 69),
>ASD/PFO closure (n = 201) and Maze (n = 156). Mean pre operative
>New York Heart Association function class was 2.2 ± 0.9. Twenty eight
>patients had ejection fraction less than 20%.
>
>
>
> Results 
>
>
>
> Thirty-day mortality was 1.28% (n = 8), Operating time, bypass time
>operating averaged 189 ± 52, 113 ± 35 minutes, respectively.
>Three patients had conversion to sternotomy. Fifteen patients (2.4%)
>underwent reexploration for bleeding. Average length of hospital stay from
>surgery to discharge was 6.85 ± 3 days. Ten patients (1.6%) had
>neurological events. Renal failure required hemodialysis in 5 patients
>(0.81%). Long term follow-up results are awaited.
>
>
>
> Conclusions 
>
>
>
> This study demonstrate that this simplified technique of ultra minimally
>invasive mitral valve surgery is reproducible and provides the least
>invasive operative approach with low mortality and morbidity with good
>cosmetic results.
>
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