[HSF] RCA osteal lesion-osteal reconstruction

zzhoumd at pol.net zzhoumd at pol.net
Thu May 1 04:35:39 EDT 2008 

Tom, 

With all respect and nothing personal, here is my view. I know many people may disagree with me.

In this day of age, a randanized trial is almost impossible without strong industrial backup. If I have sufficient funding, I will love to be part of such trial. In fact, we have talked to a few compamies, it is very difficult for varies reasons..

I think NIH should fund trial like this which has more clinical significance than some programs they are funding now. It is obvious that only a few academic centers are leaders in the innovative technologies. Most cases are done in community hospitals which make such trial even more difficult.

The current criteria to judge a surgery based on the mortality or morbidity ignores the patient's choice/acceptance/invasiveness, just like the debate has been repeated many times on CABG vs PCI. I have many patients who will not accept a standard open heart surgery but will accept a mini invasive one even I told them this may not be ideal for them. 

In a few years, we will see more data. 

Zhandong Zhou



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-----Original Message-----
From: tdmartin2000 at aol.com

Date: Wed, 30 Apr 2008 22:34:53 
To:OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] RCA osteal lesion-osteal reconstruction


Hal
I commend you and others such as Bill Turner in Tyler who have done this the right way. You have been very methodical, careful and insightful.But you are the exceptin and not the rule. ?What really gets my hair standing on end is the thought and talk of doing minimally invasive procedures in order to please or appease the cardiologist and keep from loosing cases and $$. I can actually see where mitral work is possibly ideal for this type of approach. I would ask you, however, that if you are going to tout it as a technique that is as good or better that you publish it and compare it to a case matched control of all your other mitrals that you have done in the past or even better yet, do a prospective randomized trial. 
As for coronary work, I personally think that in most intances it is doing an injustice to the patient. It is really hard to beat the standard coronary bypass that Tagart, Guyton and others have talked about in their lectures around the world. It's going to be really hard to even come close to the less than 1% mortality, 3 to 5 day hospital stay, 1% stroke rate, and a 90 to 95% one yr patentcy of all grafts, and a cost to the hospital of less than $15,000. It would be interesting to take a poll of cardiac surgeons across the country and ask them which they would rather have if they needed a coronary bypass- full sternotomy and standard coronary bypass or a minimally invasive approach with robotic takedown of their mammary.
Tom


-----Original Message-----
From: Hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Tue, 29 Apr 2008 7:34 am
Subject: Re: [HSF] RCA osteal lesion-osteal reconstruction



Tom,
  I beg to differ.  Have you honestly ever sent a patient home on  POD#2 
after a complex mitral valve repair?  I have.  Though the  learning curve is 
daunting, I'm quite satisfied that I can offer selected  patients an operation 
comparable or even better than the open approach.   For one thing, the high 
percentage of CO2 in the closed right chest means I  virtually never see bubbles 
on 
the left side of the heart during TEE.  In  contrast, that never occurs with 
sternotomy.  None of the nearly 50  robototic valve patients I've done have had 
a postop neurologic deficit. With  the optics on the robot, I can see the 
subvalvular structures better than with a  sternotomy.  I'm now doing repairs 
robotically that are at least as complex  as what I do open.  I still don't use 
robotics for calcified annuli.   The instruments are too flimsy to reliably 
excise those areas.  
  Anyway, Tom, for us to stay relevant, we have to innovate.   Otherwise, we 
will eventually go the way of the blacksmith.  In understand  your reluctance 
to embrace minimally invasive approaches.  What are the  residents going to 
do?  One thing I can tell you the stuff I'm doing can't  be done by a kid who 
was taking out colons 2 years earlier.  It's a tough  problem, but we have to 
embrace it.  I'm hearing the same things about  AVI's.  Well, if you don't learn 

to do that, you will probably lose a fair  amount of your aortic valve work.
 
Hal



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