RES: [HSF] Who Should Remove Chronic Pacemaker Leads?

[Tea Acuff]

No. It may come to legal action, but what we as a specialty should do is first start setting reasonable standards for us. We have let the ACC, AHA, and other groups decide what we can do. It has been difficult for me to get CMR priviledges because they say "cardiac specialists" should spend three months and have skills in another imaging format. Of course radiologists can learn complex pathoanatomy and physiology at two weeks of CME. We have unique values to bring to the table. Thes are values that are critical to the patient. The others always ask us after the fact what we see. Why not before they see?

EP implants are not that difficult, but the criterion for entry to implant require complex EP theory (testing) even though some EP doctors just read a report of EF< 35% as the defining test for implant. On the other hand complications of implant are quite difficult to manage, but that component of the spectrum of problem solving that is required by these patients is largely ignored in favor of sometimes obscur EP perspectives.
Thus the surgeon can not do the simple implant, but can can without any delay be called to fix the complications of the same. Our societies are a sleep at the wheel or in the back seat ? with the referring speciality while the patient goes off the cliff waiting on a surgeon to show up. I think Hal is correct that our training programs also have too much politics or focus on special business to help much either.

tea


----- Original Message ----
From: Theofilo Gauze <tgauze at cardiol.br>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, October 22, 2007 4:04:48 PM
Subject: RES: [HSF] Who Should Remove Chronic Pacemaker Leads?


Dear Hal, 
You mentioned one of what I think is the most important points in today's
practice. The fact that the clinician associations decide to "gave birth" to
rules that say's who is entitled to do "surgical" procedures in simply
ridiculous. The problem is that our societies (I mean surgical one's) don't
move a feather to discuss or change that. I firmly believe that the time has
come to challenge those rules in court.
Theofilo Gauze



-----Mensagem original-----
De: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Em nome de Hgrmd at aol.com
Enviada em: segunda-feira, 22 de outubro de 2007 06:59
Para: OpenHeart-L at lists.hsforum.com
Assunto: Re: [HSF] Who Should Remove Chronic Pacemaker Leads?

Ani,
  You underestimate your abilities as a surgeon.  Learning how to  do lead 
extractions was picked up about 5 years ago by a senior surgeon in my
group, 
and about a year ago by a junior surgeon.  We had them do it since  there
was 
only one other surgeon in town, Charlie Byrd, doing it at the  time.  All of
the 
cardiac surgeons in my group, including me, are adept at  inserting 
pacemakers.  I've done literally thousands.  Thus, we have  some wire skills
anyway.  
Just because the academic institutions are set up  with nonsurgeons doing
this 
potentially dangerous procedure doesn't make it  right.  Perhaps all of you
in 
the academic ivory towers should  critically look at the true M and M 
associated with the inherent delays that  occur when a perforation is
emergently 
passed off to the surgeon.  There's  no reason, other than pride and greed,
that 
true cardiac surgeons couldn't be  trained and allowed to do these
procedures 
at your institution.
  A few months ago, I was talking to my friend, Dr. Byrd, who designed  the 
equipment currently used to extract leads.  He has a arterial line in
place.  
If the pressure unexpectedly drops for more than about 45 seconds  while
he's 
doing one of these extractions, he immediately does a  thoracotomy.  He's
yet 
to regret that policy.  He never goes on  pump.  His results are
outstanding.  
I'd much rather get my infected  lead removed here than at yours or
Michael's 
institutions.

Hal



************************************** See what's new at http://www.aol.com
_______________________________________________
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
-----------------------------------------

_______________________________________________
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
-----------------------------------------