[HSF] Toronto SPV

Wed May 9 11:52:48 EDT 2007

Ajit ... these quotations were just magnificent.

NFA

On 5/9/07, Ajit Damle <damle at cableone.net> wrote:
>
> I agree with Murtaza. Although I do not want to off-pumps personally,
> there
> is good evidence that it can be, at the least, as good as on-pumps.
> Stentless valves, and particularly robotic surgery are not in that
> category...........yet.
>
> BTW the great guy who said "it is hard to predict, especially the future!"
> was Yogi Bera!
>
> Another apt quote, if you are planning research, is " If you don't know
> where you are going, you will end up someplace else!"
>
>
> Ajit Damle
>
>
>
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of murtaza
> chishti
> Sent: Tuesday, May 08, 2007 10:29 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Toronto SPV
>
> ani,
>
> some great guy said,"it is hard to predict, especially the future!" With
> robotics, it is currently hard to replicate what you can do thru
> coventional
>
> approach, it may just be a stage in evolurion of robotic heart
> surgery.will
> the robot be consigned to the  dust bin(trash can, Americans might
> correct)
> of history? only time will answer that question.
>
> i think you can not lump OPCAB together with other "fads and fashions" you
> mention.
> there may not be hard statistically sound  evidence OPCAB is better that
> than ONCAB, it is amply clear it is as good as ONCAB, certainly in high
> volume centers with stringent training and quality controle. i would not
> refer to OPCAB in the past tense.
>
> murtaza
>
>
> >From: prasannasimha <prasannasimha at gmail.com>
> >Reply-To: OpenHeart-L at lists.hsforum.com
> >To: OpenHeart-L at lists.hsforum.com
> >Subject: Re: [HSF] Toronto SPV
> >Date: Wed, 09 May 2007 07:41:28 +0530
> >
> >>I believe the likes of Mohr who do _not_ believe that robotics is _not_
> >>the future of minimally invasive surgery
> >
> >Ani,
> >A double negative is a positive. Are you meaning that Mohr believes or
> >doesn't believe in Robotics for mitral's - your subsequent statement says
> >no (and I think Mohr also doesn't use the robot for it)
> >Prasanna
> >
> >
> >
> >Ani Anyanwu 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.aolc
> om/>>.
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