Re: AW: [HSF] Tea´s thoughts-OT
Tea Acuff
tacuff at swbell.net
Fri May 2 16:13:00 EDT 2008
somehow I don't think that will be the analogy
tea
----- Original Message ----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, May 2, 2008 9:01:23 AM
Subject: AW: [HSF] Tea´s thoughts-OT
Tea,
One letter more and you´ll write a Shakespeare theatre piece...
Roberto
-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von
wftjrtyler at aol.com
Gesendet: Donnerstag, 1. Mai 2008 02:10
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: [HSF] RCA osteal lesion-osteal reconstruction
......from "runnin on empty".....Jackson Browne....~78......."it takes a
clear mind........" had this thread in mind......bill turner
In a message dated 4/29/2008 9:22:22 P.M. Central Daylight Time,
tacuff at swbell.net writes:
I might suggest that we all take a step back and think through as best as
we
can the implications of the things that we propose as proper perspectives.
If I may drift across some of the recent threads, we have surgeons
appealing
to standard evidence based positions and others pushing for the technical
improvement and innovativation that seemingly drives patients to the better
alternative of surgery. In the middle of this we have semicatheter based
approaches with a few surgeons trying to stay ahead of the frontal assult by
interventional cardiologists to develop the new surgeon of the future.
Ani recently stated out of whole cloth uncontested that AVI (I think is the
acronym) is its own standard and rightly so. This opinion is paramount to
my
observation (or rant) that EBM is more about the observation of doctors
behavior to treatment of their patients than it is the more commonly held
dictum
that EBM is the analysis of patients behavior to therapy for their disease.
I
think it is both but we can not lose the clarity that these are very
different things and our interventions in any order and every order greatly
impact
the possible outcomes of patient-doctor-disease interactions over the life
of
said interactions. How does an either/ or trial, the mainstay of EBM, deal
with this complex interative system? Don't the patients also impact this
before
and throughout their so called informed consent discussions especially in
EBM?
But even to the narrow point raised by Ani. Which way shall it be? Are AVI,
PCI, medical therapy (?inoperable??), robotic AVR and "AVR" all different
therapies evaluated on their own terms? If so, is the same true for PCI,
ONCAB, OFFCAB, hybrib, TECAB, all arterial CAB etc? Do we start thinking
formally
and especially OFFICALLY about how all of these interact or do we
categorize
each into their own orbits or perhaps speciality based solar planetary
system? Aren't we by default actually doing specialty based planetary
therapy? Do
the "best" of us practice orbital, solar planetary or galaxy medicine? Do
we
need all of these? Do we as CV surgeons step forward in the clinic for the
diagnosis and follow later the post op therapies? Do we get CT scans for our
demented and scope our anemic patients, or just worry about our our
protocols
for CV patients. Shall we call a spade a spade or hide nakedly behind the
sign
named doctor and picket fences we call best
practice in our literature? Who are we?
tea
----- Original Message ----
From: kenny herskowitz <animal2830 at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, April 29, 2008 7:35:24 PM
Subject: Re: [HSF] RCA osteal lesion-osteal reconstruction
ditto
On Apr 28, 2008, at 10:23 PM, tdmartin2000 at aol.com wrote:
> Z
> I hate to disagree but it isn't always what the surgeon is
> "comfortable with". The data to date would not support a robotic
> anything over conventional surgery. I think in most cases, surgeons
> are using the thought that cardiologists are sending pts to surgery
> because of the robot or mini approach because they think it is
> better in some way. What they need is good education on each
> approach. I bet if?we were totally honest with our cardiologists
> about minimally invasive procedures and told them that the data to
> date doesn't support any percieved benefit in terms of pain, length
> of stay, mortality or morbidity? and in fact in many cases the
> results are not as good, they would think twice about it. And if we
> educate them properly on the really excellent results that
> conventional surgery gets as compared to medical tx or stents they
> would be very receptive. In the end what we really need to do is do
> what is really the best for the patient.
> ?
> Tom
>
>
> -----Original Message-----
> From: zzhoumd at pol.net
> To: OpenHeart-L at lists.hsforum.com
> Sent: Mon, 28 Apr 2008 12:02 am
> Subject: Re: [HSF] RCA osteal lesion-osteal reconstruction
>
>
>
>
> Tom,
>
> The most important thing is surgeon's choice, what ever he feels
> comfortable,
> whether robot or sternotomy.
>
> One of the interesting thing that happens with mini invasive
> approach, is to see
> that cardiologists are sending some patients for surgery that you do
> not see in
> the past, I.e. Patients they used to treat with medication and stents.
>
> Z Zhou
>
>
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: tdmartin2000 at aol.com
>
> Date: Sun, 27 Apr 2008 18:33:59
> To:OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] RCA osteal lesion-osteal reconstruction
>
>
> I would have to agree with those opinions so far that a PCI with a
> large stent
> is probably the first option. If that is not feasible or safe then a
> standard
> single vessel bypass to the right or PDA. Your choice of grafts but
> in a 60 year
> old I might consider a RIMA. I hear all this about robots and
> everything else
> but come on guys- in an era where we are chiding the cardiologists
> about results
> of PCI and how the results of coronary bypass is better- why would
> you choose a
> potentially inferior operation in a 60 year old patient that you can
> do a
> standard operation via a sternotomy with a pump with cardioplegia
> and give her
> excellent 10 plus yr results with a mortality of less than 1% and
> probably in
> the 0.5% range and a hospital stay of 3 to 4 days?!
> Interested in the feedback.
>
> Tom Martin
> U of Florida
> Gainesville
>
>
> -----Original Message-----
> From: Prasanna Simha M <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Sat, 26 Apr 2008 11:32 am
> Subject: Re: [HSF] RCA osteal lesion-osteal reconstruction
>
>
>
> A single RCA lesion should receive a PCI if possible. If not then it
> can
> receive any graft. No arterial graft has been shown to be better
> than a
> saphenous vein on the right side (In fact radials have been found to
> be
> worse if the lesion is less than 80 %). There is no survival benefit
> of a
> precrux arterial RCA graft and the RIMA is better preserved for the
> left
> system where there is a possible shred of an evidence that a second
> IMA may
> be better.
> Prasanna
> On Sat, Apr 26, 2008 at 8:47 AM, yadav del <yadavluck at yahoo.com>
> wrote:
>
>>
>> We have a 60 yr old female patient admitted with acute inferior MI
>> with
>> RV extension . At admission she was in shock and complete heart
>> block,severe
>> MR and severe TR.She improved with temporary pacemaking.
>> Repeat echo after 3 weeks shwoed mild mr mild tr, EF 60% and coronoro
>> angiogram showed RCA [large and dominant] with 98% osteal lesion .
>> Dobutamine echo showed viable RCA territory.
>>
>> What is the optimal surgical treatment? RCA graft or osteal
>> reconstruction?
>>
>>
>> ---------------------------------
>> Be a better friend, newshound, and know-it-all with Yahoo! Mobile.
>> Try it
>> now.
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>
>
>
> --
> Prasanna Simha M
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