[HSF] afib theory

[Tea Acuff]

I am a little disappointed that I did not make it to voo-doo (which is a recognized field), and you think I am still stuck in mumbo jumbo.

We certainly can't have any stinkin' thinking going on in surgery if we have an operation that works. The public will soon wake up to us so we will be busy all day and every day doing robotic full mazes on the 10 million in afib for the next decade. I better renew my yellow page number. They should be able to follow our present EBM and logic. If not, we can just repeat what we said last time until they come around or cite an expert authority. 

I did hear on a national talk show today about the Baxter heparin "problem". Callers were sure that their relatives had the problem since their elderly relative lost a leg and they couldn't figure out exactly what was going on. The talk show guy, a conservative lawyer, said, "You are going to sue aren't you? There had been 17 deaths connected to the bad heparin. I not usually for the plantiff bar unless the patient is dead." Incidently, he commented that his dad had been on heparin "for years" and it "also comes in a pill form, I think". Yeah, I think they pretty much have the surgeon version of EBM down. Got to go, someone is calling...probably a patient looking for a maze on pump sternotomy...

tea




----- Original Message ----
From: "Hgrmd at aol.com" <Hgrmd at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, March 10, 2008 6:48:17 AM
Subject: Re: [HSF] afib theory

Tea,
  That was a flood of philosophical mumbo jumbo regarding AF  surgery.  To me
, it's pretty simple stuff.  Just do a set of lines  that you know will work.  
As for the ganglionic ablation, there is scant  evidence that doing it has 
any long term benefit in curing atrial  fibrillation.  Without citing a source, 
I heard Damiano say there was  evidence the ganglia regenerate with time.  
Certainly, Jim Edgerton's  results with ganglionic ablation presented at the last 
STS was less than  impressive.  
  PVI works for intermittent AF.  For persistent or continuous  AF, the 
mitral isthmus lesion and ablation of the coronary sinus are  required.  Cox and 
Damiano insist that a full set of lesions is required  for the right side as 
well.  I'm not convinced, and have had excellent  results with the cavotricuspid 
isthmus lesion only.  However, I may go  ahead and do the full set in the 
future, simply because it's no big deal.

Hal



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