[HSF] angiogram and Denying CABG

[Michael Firstenberg]

of course, not to be critical in a negative way - but if a hospital system
does not have the overall resources to deal with some of these train wrecks
appropriately then maybe they should be sent to PTCA instead of surgery -
even if it means they are getting multiple stents that major centers would
bypass.  That is also assuming the patients do not have/get/etc the options
of going someplace else.  Remember, someone is always watching those
outcomes and a surgeon may not want to get "blamed" for weaknesses within
the system that she/he has to practice in.  I am not saying this is the case
here - but there are many medical and non-medical reasons to turn people
down for surgery - even if they have clear indications.


-michael


On 10/10/07, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
> What happens to the patients you refuse? Do they have medical therapy only
> or angioplasty? If angioplasty then maybe refusal is not right term as based
> on your assessment of the angiogram angioplasty is preferred (for whatever
> reason). In most settings now, however, patients sent for surgery are those
> unsuitable for angioplasty, so if you turn them down then it means end of
> the road (unless transplant), that is assuming there is indication for
> surgery.
>
> What is the LV like in patients you turn down?
>
> In the context of severe LV dysfunction in patient presenting with heart
> failure, I think it is reasonable to turn patients down who have poor
> targets as chances of benefit are low (as good targets is a prerequisite for
> achieving recruitment of hibernating muscle). That such patients can have 1
> mm vessels bypassed and survive a CABG (the surgeon's usual criteria of
> success) means nothing as many still progress in heart failure (and present
> to us needing a reop transplant sometimes within a year of CABG proofing
> CABG was a futile operation).
>
> For patients with preserved LV function, however, it would be most unusual
> to have coexisting coronary disease of such severity that is deemed
> inoperable.
>
> Ani
>
>
>
>
> > Date: Tue, 9 Oct 2007 20:44:11 -0700> From: john_pj15 at yahoo.com> To:
> OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF] angiogram and Denying
> CABG> > Are there any guidelines about what type of vessels should be
> considered not suitable for grafting based on angiography> I think there is
> lot of variation between surgeons in interpreting and accepting patients for
> CABG. Many times we note that vessels which were considered small by
> angiography are not so when we look at them on table.> > We refuse about 20%
> of the patients referred for CABG based on angiograms.> I wish to know what
> is the situation with others.> > > ---------------------------------> Need a
> vacation? Get great deals to amazing places on Yahoo! Travel. >
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