[HSF] Honest discussion-Hybrid Coronary Revascularization

[Ani Anyanwu]

Hal
 
True what you say except one disagreement. It is not correct to say the safety and efficacy of minimally invasive surgery has been demonstrated. There is a problem with the literature because on balance surgeons who do minimally invasive techniques in great numbers tend to be more skilled than those who don't so effectively what you see when you look at Cosgrove's series, Vanerman's series,  Mohr's series etc is comparing an above average surgeon to the rest of us. I bet if you put Mohrs results side by side with Dr David who is a sternotomy surgeon you wont see those differences. The likelihood is that if Mohr did all his operations via sternotomy his results would be even better. Indeed one of my colleagues recently visited Liepzig recently saw a mini-mitral end in a similar way till the 'botched' one you described, an outcome that would likely not have been if done through sternotomy. Most experienced mini-invasive surgeons do truly deliver superior results but it is often not because the technique is itself superior but because they are superior surgeons or have better teams. Whatever they do tends to work and be good. Or would you suggest that if Vanerman or Mohr started doing all cases via sternotomy they would suddenly have worse results? 
 
This bias is part the reason why when low volume or the 'average' cardiac surgeon takes up mini-invasive surgery on the expectation that the results are better (as shown in the literature) they often face a rude awakening. The reason why you can get good results with the robot Hal is not because robot is safer or as good, but because you are good at mitral repair. 
 
Of course the data will show that these mini-techniques are all superior - and that is the message filtering to our patients. Recently we lost a mitral patient (done via sternotomy) and the family were blaming themselves saying if only they had gone for the davinci things would have turned out different....
 
 
Ani



> From: Hgrmd at aol.com> Date: Fri, 23 Nov 2007 09:06:42 -0500> Subject: Re: [HSF] Honest discussion-Hybrid Coronary Revascularization> To: OpenHeart-L at lists.hsforum.com> CC: > > Mike and Tom,> I hear what you are saying Tom regarding minimally invasive surgery. > There definitely should be an honest discussion with the patient regarding the > advantages and disadvantages. I'm also aware that you see botched cases such > as the robot mitral which ended up with an artificial heart prior to death > (not my case). However, I don't think it's accurate to say that no series exist > that demonstrate the safety and efficacy of minimally invasive surgery. > Just look at Fred Mohr's series with MIDCAB's and minimally invasive mitrals. > Vanermen, Hargrove, Colvin, and many others have similar results.> Yes, there is a painful learning curve with these techniques. However, if > one is truly patient and committed, equivalent results can be achieved. The > problem is that our specialty has many procedures that are slowly dying out. > Not many of us believe that a 5 vessel CABG is a growth industry. The > public is clamoring for less invasive techniques. It is our duty to try to > safely accommodate them. A frank discussion about the safety, advantages, > disadvantages is imperative for the ethical treatment of the patient. However, to > ignore minimally invasive techniques, or to only do them when a patient > demands them is not the future of our specialty.> > Hal> > > > **************************************Check out AOL's list of 2007's hottest > products.> (http://money.aol.com/special/hot-products-2007?NCID=aoltop00030000000001)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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