[HSF] redo mitral video nope

[Tea Acuff]

I apologize for my ineptness in transferring images with my text. In trying to review them I am not satisfied with the resolution or my ability to get a single cardiac cycle to loop. I probably can get single a picture, but it will require some different software and a little time.
 
The point of the case (quixotic) is that I did a Lima to the Lad which failed and a mitral repair posterior resection which did not seem to fail by my suture annuloplasty, but by obvious reprolapse of the posterior leaflet. There was perhaps some mild anterior prolapse and thickening of the valve leaflets in general. The annuloplasty suture and most of the few pledgets that I use for that were nicely covered in scar, I am reasonably sure that a complex repair could have been accomplished, but I choose a more expedient replacement associated with tricuspid ring and RSV to the Lad in this 75 year old. 
 
Admittedly I could have just made a series of errors in the first operation, but I would suggest despite the implications of our "guidelines" or expert opinion, the behavior of populations on the average at least requires both good results and bad results with the "preferred" therapy. Ani described a variety of ways that repairs fail, but most discussions emphasize the data that suggests one technique is preferred ignoring the distribution of failure in both or competing techniques. The unaddressed question in all of this is in which sub groups of patients that can undergo the "preferred" therapy is the inferior therapy actually better.
 
One example of this effect that I recently read about was a finding that was called "reverse epidemiology". (I am not sure this moniker makes sense, however.) The observation was that in sub groups of chronic disease patients that live, the "lucky unlucky", such as ESRD or very elderly, traditional risk factors like obesity and hyperlipidemia seem protective. Further, therapeutic modification to reduce these risk factors do not help the longevity of these lucky unlucky groups. Thus these patients are in some sense harmed by best therapy for the many.
 
I can imagine in our rush to make larger and more inclusive studies to "universalize" therapy we are losing more and more ability to discriminate "among" patients. (I think that I am still talking about medicine and not politics, colleagues, both of which suffer immeasurably by political correctness if not hyperbole.) Further in our rush to proscribe guidelines we will subject some to harm by commission. The more successful our efforts toward universalization, the more of these minorities (all nonmajority) we will either not help or hurt.
 
I will keep working on my pictures so you can believe your own lying eyes, not just my contrarian thinking.
 
tea