[HSF] Never seen this before
Tea Acuff
tacuff at swbell.net
Sun May 25 20:42:12 EDT 2008
Pardon me. I know almost nothing about it. It is as Don from Down Under says. I only see what I believe as I can not recognize the facts. This is what makes me so absurb.
But we have had this argument before it seems to me. There is nothing wrong with the mechanical valve in itself. It works great. You know the argument now don't you. If the mechanical valve alone is a problem in a complex system what about The LVAD? Now that is a really complex valve...
tea
----- Original Message ----
From: "DukeB60 at aol.com" <DukeB60 at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, May 25, 2008 8:44:40 PM
Subject: Re: [HSF] Never seen this before
Tea,
I'm am quite certain it is not the VAD that is so bad in all cases. In
fact the VADs themselves have progressed to a level of viability and
credibility that offers very acceptable quality of life for several years. And they
are cost effective to boot. Anyone who has done them can tell some amazing
stories of lives saved and very, very grateful patients and families. In the
right patient a HeartMate II or similar pump can give a rather good quality
of life for a long time. It is just that to have success in implanting such
devices you need a level of institutional and personal commitment unlike but
very few areas of medicine we are familiar with. Not too many care givers or
centers are willing or capable of that level of commitment to have success.
Care of these patients is extraordinarily complex with virtually every organ
system, metabolic mechanism and humoral and hematologic response involved in
a way not like other patients - even cardiac patients. VADs themselves,
especially the newer iterations, have the capability of a level of success
making them a very viable option in the right circumstance - but not everyone or
every institution should do them. The REMATCH trial proved beyond a doubt
the value of VAD destination therapy that was more beneficial than but a few
interventions or therapies ever introduced or studied. And that study was done
with a fairly rudimentary version of pump compared to what is available
today and on the horizon. But what was also learned was that the results of
various centers was not equivalent and while some could be successful others
were much less so. It is the level of commitment that is daunting. The problem
is certainly not the viability of the VAD itself. I just got burned out
doing them for ten years and pretty much by myself for the last five, as did my
wife. At the same time, I will remember my experience with VAD therapy as
some of the most challenging yet rewarding of my career. VADs are here to
stay.
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 8:15:07 P.M. Central Daylight Time,
tacuff at swbell.net writes:
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>
>
>
> **************Get trade secrets for amazing burgers. Watch "Cooking with
>
Tyler Florence" on AOL Food. >
(http://food.aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002)>
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