AW: AW: [HSF] New crazy operations and solutions at HZL

[Ani Anyanwu]

> will the cardiologists (or even surgeons) who put them in be held to the> same outcomes standards that we are for performing operative AVRs in terms> of STS outcomes and reportability? Afterall, it is an "isolated aortic> valve replacement".....right?> > -michael
Michael
 
Percutaneous and transapical valves will not and should not be held to the same standards as an open AVR - to do so is unrealistic and unfair. 
 
That is probably why the nomenclature AVI was coined to emphasize this difference. The former (surgical AVR) is a valve replacement with native valve excised and replacement performed with a variety of prosthesis and techniques adaptable to the surgical findings; the latter AVI is squeezing a prosthesis into all aortic roots with no scope for adaptability. Why should we expect the same results? The question is at what cost one receives the superior surgical results - depending on the cost (e.g. invasiveness, pain, morbidity, mortality) some, or many will opt for the less invasive option even knowing the 'results' may not be as good.
 
The procedures are very different and for all alternative therapies, each should be considered on its own merit with the risks and benefits of one procedure compared with another. Another alternative we must not forget in the octogenerian is medical therapy.
 
Ani
 



> Date: Sat, 26 Apr 2008 11:19:17 -0400> From: msfirst at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: AW: AW: [HSF] New crazy operations and solutions at HZL> CC: > > Patient selection> Patient selection> Patient selection> > > .... and when the entire world starts to look at your outcomes through a> magnifying glass then maybe you will think twice about excercises in> techniques over judgement.> > look at all of the problems now with LASIK> the rampant abuse of PFO closures for stroke> if the results are better with perc valves then fine that is evolution - but> will the cardiologists (or even surgeons) who put them in be held to the> same outcomes standards that we are for performing operative AVRs in terms> of STS outcomes and reportability? Afterall, it is an "isolated aortic> valve replacement".....right?> > -michael> > > On 4/26/08, DukeB60 at aol.com <DukeB60 at aol.com> wrote:> >> > Hal,> > I completely agree with all you said.> >> >> > Ed> >> > Edward P. Raines, M.D., J.D.> > BryanLGH Cardiothoracic Surgery> > BryanLGH Medical Center East> > 1600 South 48th Str.> > Lincoln, Nebraska 68506> > Office: 402-481-8430> > Cell: 402-730-9242> > Fax: 402-481-8429> >> >> >> > In a message dated 4/26/2008 5:24:11 A.M. Central Daylight Time,> > Hgrmd at aol.com writes:> >> > Ed and Michael,> > I'm a big believer in offering heart surgery to the right old people.> > Just this week, I did a mini-AVR on a 91 yo lady and a AVR,> > mitral repair> > on an> > 87 yo man with multiple patent grafts. Both are doing quite well. In> > fact,> > the 87 yo man was sitting in the chair on morning of POD#1. The first> > thing> > he did when I walked in was offer me his hand and thank me for being his> > doctor and taking a chance on him. Yes, these patients are more frail> > with> > more> > comorbidities, and the margin of error is often razor thin. However, I> > find> > the key is offering surgery to oldsters who still have a zest for life.> > The> > 91 yo lady still drove and lived alone just prior to surgery. The 87 yo> > man> > was cheerful every single time I've spoke to him. That's half> > the battle.> >> > In contrast, don't offer high risk surgery to a old patient who is> > completely> > sedentary, depressed, with no family support.> >> > Hal> >> >> >> > **************Need a new ride? Check out the largest site for U.S. used> > car> > listings at AOL Autos.> > (http://autos.aol.com/used?NCID=aolcmp00300000002851)> > _______________________________________________> > 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> > -----------------------------------------> >> >> >> >> >> >> > **************Need a new ride? Check out the largest site for U.S. used> > car> > listings at AOL Autos.> > (http://autos.aol.com/used?NCID=aolcmp00300000002851)> > _______________________________________________> > 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> -----------------------------------------
_________________________________________________________________
Be a superhero and win! Play the Iron Man Mashup Game 
http://www.ironmanmashup.co.uk