SD closures and Re: [HSF] Mitral Valve

Sat May 5 02:34:43 EDT 2007

Very well said Murtaza .... reminds me of Sofi Talking ....
BRAVO ..... totally agree with Ani, Dr. Bachet and You ...

On 5/4/07, murtaza chishti <cmurtaza at hotmail.com> wrote:
>
> 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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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC