[HSF] Aprotinin

[Tea Acuff]

Forgetting both the "sandy" foundation of economic resources and the utilitarian definition of good, I always wondered whether some operations for complex pediatric disease regardless (or more perhaps because OF resources) were more about "bet I can" than "yes WE should". Clearly a stable pattern of access (one of the reasons I keep pushing access to the front of arguments for guidelines) is required for anything more than so called corrective operations/ options. It reminds me of the earlier (and perhaps now recurrent) issue of itinerant surgery. Or conversely (or upside down) the proponents of only major centers as proper access subject the diaspora of patients to solving the suitable gradient of access problem. Understand?  Agree? 
 
tea


----- Original Message ----
From: "ICHFNO at aol.com" <ICHFNO at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, November 6, 2007 5:34:21 PM
Subject: Re: [HSF] Aprotinin

Tea;

We have done Stage 1 Norwoods in 4 countries, 2 of those moved on to   develop 
independent Norwood programs although only 1 has sustained this effort,   
Belarus. We have Stage 2 survivors in all 3 countries that we did, and the  
Belarussians have Stage 2 survivors that they have done. We have Stage 3  survivors 
in one country, but they no longer do them and they never graduated to   
successful Stage 1 without us. I do not recommend developing a Norwood program  in 
any country unless they have moved to neonatal surgery with an overall   
mortality rate of less than 15% and an arterial switch mortality rate of 10% or  
less. 

Three more of our programs are pushing for Norwood help, but at present we  
are resisting because of the above criteria. We will have our 14 year 
experience  hopefully published in Cardiology in the Young in an upcoming issue, that 
is if  they accept our revisions. 

We probably only do about 4-8 per year, we are not always in country when  
one is born, and only once have I flown into a place just to do a Norwood. 

This operation and the subsequent interstage follow-up requirements are not  
for every country, addtionally most countries have to many other kids that 
need  routine ops and financial constraints that preclude a Norwood program. Not 
to  mention the ethics of the " Good for the many outweigh the good for the 
one" to  qoute a famous Vulcan.

Bill



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