Re: [HSF] longevity of bioprostheses

[rwmfglycar at aol.com]

Giulio,
Why would he ever receive a new prosthesis?
There are two ways of looking at this:
a) make a decision in which the desires and interests of the patient are paramount;
b) make a decision in which the total population interests are paramount.
System a) is the traditional way, at one time controlled by the conscience and ethics of doctors, but now rendered very complicated by efforts to protect patient interests and remove power from single individuals.
System b) is what happens when health is totally controlled and financed by the State. The Minister or Secretary or Gauleiter of Health asks the question: how are the interests of the total population served by spending x thousands of currency on this one patient versus spending them on something else e.g. vaccines for homeless children?
  In this case the answer under system b) is clearly no device replacement. Under system a) the outcome is not clear. Dementia excludes the patient from the decision. I would not hesitate to say that there can be no good in putting a demented patient through a rereplacement. But there are many reasons including, in some parts of the world, the exchange of money that might result in a repeat procedure.
Bob


-----Original Message-----
From: Giulio Rizzoli <giulio.rizzoli at unipd.it>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 3 Jan 2008 11:57 am
Subject: Re: [HSF]　longevity of bioprostheses


At 17.20 03/01/2008, you wrote: 
>I have always been wondering what the real longevity of bioprostheses is. 
>Because for example, if you put pericardial valve at the age of 70, then the 
>patient become 85 yo with low ADL and dementia, and also develop gradual AS, 
>not acute AR due to breakdown of prosthesis, probably reoperation is not 
>performed. 
 
He could probably receive a percutaneous new prosthesis via phemoral or cardiac apex 
  Giulio Rizzoli 
Giulio Rizzoli MD FETCS 
Cardiochirurgia Padova 
tel. 049 821-2408 
fax 049 821-2409 
e-mail giulio.rizzoli at unipd.it 
 
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Es war ein Traum .... Heinrich Heine 
 
 
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