[HSF] Toronto SPV
Nasser F. Abou'Seada
nfaabouseada at gmail.com
Wed May 9 11:50:39 EDT 2007
very well said Dave. one can not beat the logic, nor the experience.
NFA
On 5/8/07, David Harris <drdharris at yahoo.co.uk> wrote:
>
> Ani,
>
> You cannot compare device failure (stentless valve)
> with a potential failure due to a different surgical
> approach (robotic). I cannot think why the physical
> repair using a robot should be any different -
> although it will initially take longer. So why should
> long term results be different?
>
> I think your words fashions and fads should be
> replaced with ``innovations and ``imagination``.
>
> As for off pump surgery - I started off doing a lot,
> and a few years ago dropped off to 20% after
> constantly listening to people like you. But
> eventually, logic and results, and a visit to people
> who have the facts after keeping stringent databanks (
> like Paul Sergeant), paid off - I have not done a
> routine CABG on pump this year - and this is for the
> benefit of the patient, not just because I can.
>
> Dave Harris
>
> --- Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
> > Hal
> >
> > Maybe you said the same 8 years ago about people who
> > refused to embrace the stentless valve - go ahead
> > and keep putting in stented valves!
> >
> > I am by no means opposed to non-sternotomy surgery
> > and certainly myself intend to develop minimally
> > invasive approaches to mitral surgery (though not
> > robotic). It is however not accurate to say results
> > of robotic surgery are several years old. I am not
> > aware of any study with median follow-up greater
> > than 2 years. Indeed the FDA approved the robot just
> > less than five years ago. Even Chitwood has not
> > published 5-year data.
> >
> > It is therefore fair to say that where we are today
> > with robotic mitral surgery is where we were in 1999
> > with stentless aortic valve surgery at the time you
> > were implanting the SPV. Few people like David had
> > years experience and the rest were embracing it
> > based on the appeal, sexiness and also weak and
> > questionable data suggesting superiority. Not much
> > different from what drives the robotic revolution
> > today. So much so that, as you pointed out
> > previously, many are performing 'robotic surgery' in
> > various guises many of which are far from robotic
> > just to be on the bandwagon. Techniques for robotic
> > repair are still very much in evolution and the
> > technique is essentially experimental and in
> > evolution. Indeed if you read Chitwood's recent
> > editorial in JTCVS he makes it clear that we have
> > not yet perfected means to repair the mitral valve
> > with a robot. Fine it can be done but the way it is
> > done is far from perfect. Certainly we are not
> > replicating (and currently do not have the ability
> > to replicate) the degenerative repair we do open
> > when we do it with the robot.
> >
> > I believe the likes of Mohr who do not believe that
> > robotics is not the future of minimally invasive
> > surgery, so I will invest my energy in other
> > approaches for now. I suspect that in 5 years time
> > robotics will join a long list of techniques that
> > many will say they dabbled into 5 years before. Just
> > like off-pump surgery and other fashions and fads.
> > While it is often only retrospectively that we can
> > differentiate true advances from fads and fashions,
> > and it is true that failure to change will lead to
> > self-extinction, sadly what often drives change in
> > our specialty (circa stentless valve and opcab era)
> > is often fashion and fad rather than patient benefit
> > or evidence. How many here with P2 prolapse would
> > have a robotic repair today?
> >
> > Ani
> >
> > ----- Original Message -----
> > From: hgrmd at aol.com<mailto:hgrmd at aol.com>
> > To:
> >
> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >
> > Sent: Tuesday, May 08, 2007 5:42 PM
> > Subject: Re: [HSF] Toronto SPV
> >
> >
> > Ani,
> > The results of robotic repairs from several
> > centers are now several years old. True, they don't
> > have the longevity track record of open Carpentier
> > repairs, but the results are promising indeed. To
> > date, I've yet to reoperate any of my Heartport or
> > robotic repairs (some are over 4 years old), nor
> > have I seen a bad postop echo from these cases.
> > Will they prove to be as durable as my open cases?
> > Time will tell. In the meantime, you go ahead and
> > do all of your repairs via sternotomy.
> > Hal
> >
> >
> > -----Original Message-----
> > From:
> >
> anianyanwu at hotmail.com<mailto:anianyanwu at hotmail.com>
> > To:
> >
> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> > Sent: Tue, 8 May 2007 6:58 AM
> > Subject: Re: [HSF] Toronto SPV
> >
> >
> > Hal
> >
> > Maybe you will be saying the same about the robot
> > someday! Goes to show that
> > sometimes we do things because they are fads or
> > fashions rather than for
> > specific benefit for our patients - now we all pay
> > the price.
> >
> > Ani
> > ----- Original Message -----
> > From:
> >
> Hgrmd at aol.com<mailto:Hgrmd at aol.com<mailto:Hgrmd at aol.com%3Cmailto:
> Hgrmd at aol.com>>
> >
> > To:
> >
> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com<mailto:
> OpenHeart-L at lists.hsforum.com%3Cmailto:OpenHeart-L at lists.hsforum.com>>
> >
> > Sent: Tuesday, May 08, 2007 6:37 AM
> > Subject: Re: [HSF] Toronto SPV
> >
> >
> > Ed,
> > I implanted a few SPV's in the late 90's, but
> > quit doing them due to the
> > extra work and hassle. Thank God I did. SPV
> > has been an unmitigated
> > disaster. I've heard that Dr. David has a
> > painfully growing experience in
> > explanting
> > these valves. I consider it a tarnish on an
> > otherwise magnificent career.
> > Without a doubt, he is the best technical
> > surgeon I've seen.
> > Hal
> >
> >
> >
> > ************************************** See
> > what's free at
> >
> http://www.aol.com<http://www.aol.com/<
> http://www.aol.com%3chttp//www.aolcom/>>.
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> === message truncated ===
>
>
> Dr. David G. Harris, FCS, MMED,
> Cardiothoracic Surgeon
> Suite 207
> Kuils River Private Hospital,
> PO Box 1200, Kuils River, 7579, Cape Town, South Africa.
> Tel +27-21-9006411
> Fax +27-21-9006412 Mobile +27-83-3309587
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--
Nasser F. Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC
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