[HSF] Never seen this before

Sun May 25 19:11:49 EDT 2008

We are sometimes nearly idiot savants. A touch of reality would humanize us and help our patients families when likely nothing can help our patients. An LVAD is just an LVAD. How many patients were preferring it above all else? Probably none.
tea

----- Original Message ----
From: "DukeB60 at aol.com" <DukeB60 at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, May 25, 2008 7:38:34 PM
Subject: Re: [HSF] Never seen this before

Tea,
    Your post is just hilarious.  My wife  is absolutely delighted we no 
longer do VADs.  In fact, I got a consult  recently on a 64yo with 7.5cm LV, AI, 
Asc.Ao.A, severe MR and EF  <20% with no insurance.  I suggested he be done 
with a VAD backup  somewhere else since we don't do them any longer.  The 
referral centers we  contacted turned him down, or at least their bean counters did.  
I  contemplated doing him here with a special exception to have a VAD as a  
backup.  I suggested this at a dinner with some other docs. and her jaw  nearly 
hit the floor.  She talked all the way home about what in the world  I was 
thinking and was I serious and followed that up with and email of the 12  
reasons I shouldn't even think about it.  She told me that was just a good  start.  
She was completely right.  It was a bad idea on my part and I  have since 
suggested that we either do the patient's surgery without a net or  send him 
someplace else.  I like being married more than I like doing VADs  again.

              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 5/25/2008 7:05:20 P.M. Central Daylight Time,  
tacuff at swbell.net writes:

I this  case praise Allah, thank God and ask them to throw you back into the 
briar  patch while they do the "important" things. What are you going to do 
with an  axial flow pump in the briar patch? Have you been reading Michael's and 
Ani's  posts lately? Ask your wife what she thinks if you don't believe  me.
tea

----- Original Message ----
From:  "DukeB60 at aol.com" <DukeB60 at aol.com>
To:  OpenHeart-L at lists.hsforum.com
Sent: Sunday, May 25, 2008 3:54:04  PM
Subject: Re: [HSF] Never seen this before

Ani,
Long story.  Our cardiologists didn't  like the complexity of taking  care 
of them, felt the new heart failure  treatments resulted in no  need for VADs 
and transplant, couldn't see a way  to meet the new  CMS/UNOS scrutiny for 
numbers and they couldn't identify  one or two  to specialize in  transplant 
and 
VADs.  After a twenty  year  program in transplant and ten in VADs they 
decided 
they didn't  want the program  any longer.  I think it is very bad timing as 
we  
lived through all the  developmental years of the pneumatic  HeartMate, 
REMATCH, the early problems with  the XVE and finally got  to the axial flow 
pumps 
when they decided to not  continue the  program.  I had done them alone for 
five 
years so didn't put  up  too much of a fight and have directed my attentions 
to 
minimally  invasive  valve surgery, arrythmia and robotics.  I must say my  
practice  is comparatively a piece of cake after all the years with  the VAD 
program  but the timing is certainly ill conceived when it  seems everyone 
else is 
moving  toward VADs rather than away.  But what can you do when the  
leadership of the cardiology group took  a different philosophical  path.

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 5/25/2008  3:40:54 P.M. Central Daylight Time,  
anianyanwu at hotmail.com  writes:

>I  used the HeartMate coring device on the first ones  but we can't reuse 
them and  since we don't do VADs any longer we ran  > out.

Ed

Why  did you stop doing  VADs?

Ani

> From:  DukeB60 at aol.com>  Date: Sun, 25 May 2008 13:30:06 -0400> Subject: 
Re: 
[HSF] Never seen  this before> To: OpenHeart-L at lists.hsforum.com> CC:  > >  
Hal,> Yes, I have done them on pump but know they can be done  without. I 
used > 
to put in VADs the same way and even though there  were  those who put them 
in 
> off pump I always did it with pump  assist while the  LV was open. What did 
> you use for the valved  conduit and the LV conduit?  Did you place the LV > 
sutures prior  to coring and what did you use to core  the LV. On the last 
case 
I  > used the Medtronic coring tool. I used the  HeartMate coring device  on 
the 
> first ones but we can't reuse them and  since we don't do  VADs any longer 
we ran > out. I thought the Medtronic  tool worked  fine and actually pretty 
much just > use it to score the LV  anyway then actually cut out the core 
with a 
15 blade > and dilate it  to  the needed size with Hagar dilators.> > 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  5/25/2008  
12:24:19 P.M. Central Daylight Time, > hgrmd at aol.com writes:>  > Ed,> Those 
are 
exactly my thoughts. Are you doing them without  pump?  In my > case, I was 
cannulated, but didn't find it  necessary.> >  Hal> Sent from my Verizon 
Wireless  
BlackBerry> > -----Original  Message-----> From:  DukeB60 at aol.com> > Date: 
Sun, 
25 May 2008  13:13:42 >  To:OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] 
Never  seen  this before> > > Hal,> I have done four so far and even  though 
they were all very old with many > co-morbidities they have  each  done very, 
very well. Rather than turn them > down for  traditional surgery  it has been 
a 
very good alternative. > >  > 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 5/25/2008 11:14:42 A.M. Central 
Daylight Time,  > 
Hgrmd at aol.com writes:> > Ed,> Did my first apico-aortic  conduit last  
Thursday. No pump. Patient was > extubated on the  table. Doing fine so far.  
Looks 
like a nice option for > patients  with a hostile ascending aorta.>  > Hal> > 
> 
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