[HSF] Changing field in Our specialty-get on board or be left out

Sun Nov 1 18:04:10 EST 2009

How many cardiologists are there after a complication requiring
surgical intervention - normally zero. I have one  cardiology
Professor who insists that if there is a complication his unit member
who has had the complication should hang around till we settle the
case and get involved in periop echo etc etc. He was really wild when
one balloon valvotomy tear occurred and no one was there when we were
weaning the patient of CPB. I think that sort of commitment is needed
from both sides to get patients up and running.I never hesitate when
he calls us as I know he will be there to help us whereas some will
dump the case like a hot potato.

On Sun, Nov 1, 2009 at 5:50 PM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
>> Everyone wants to put the stent(s) in whatever vessel and walk away - sorry,
>> doesnt work that way.........
>>
>> -michael
>
>
>
> Unfortunately, it will work that way and even if surgeon does not put them in he will still be burdened with dealing with complications and post-op issues. In one way or the other the patient willl be connected to a surgeon.  Many patients will get to the 'stenter' through a surgeon. Some patients will have 'debranching' procedures which have to be done by a surgeon, or stenter will ask surgeon to help with vascular access. Whichever way there will be some surgeon attached to the case in that way the 'stenter' can run 100 miles after 24 hours and leave you to pick the pieces. One patient recently spent 2 months in our ICU and then died after descending stent  and I never saw the stenters after the first week (in this case stenters were vascular surgeons) another was paraplegic and spent weeks, also died, again stenters nowhere to be seen.
>
>
>
> Unless you have aortic surgeons (who also do/did the open surgical equivalents) doing these I think you will find we will still be left to pick up the pieces left by stent cowboys in our various localities. The morbidity of these procedures and post-op care required is not trivial and requires as intense detail and care as for patients having surgical repair. Minimally invasive surgery etc is a misnomer and gives patients and physicians the false security that the treatment is no big deal. However, looking aat TAVI or TEVAR data, it is clear the procedures are very invasive indeed and patients are still subject to the whole gamut of complications (or some new ones) and mortality as patients having the conventional procedures.
>
>
>
> Ani
>
>> Date: Sat, 31 Oct 2009 22:44:26 -0400
>> Subject: Re: [HSF] Changing field in Our specialty-get on board or be left out
>> From: msfirst at gmail.com
>> To: OpenHeart-L at lists.hsforum.com
>> CC:
>>
>> I have no problem giving up the descending stent graft work PROVIDED whoever
>> does it takes care of these patients afterwards. I find many of this
>> patients have horrible comorbidities, poorly controlled hypertension,
>> diabetes, etc that no one wants to deal with. Many have not seen a doctors
>> in years - if ever and rarely do they have insurance (not that I care about
>> that). If a Radiologist wants to put a stent graft in, then he/she can take
>> responsibility for all of the patients other medical, social,
>> economic problems. Knock yourselves out and good luck........
>>
>> Everyone wants to put the stent(s) in whatever vessel and walk away - sorry,
>> doesnt work that way.........
>>
>> -michael
>>
>> On Sat, Oct 31, 2009 at 7:06 PM, <tdmartin2000 at aol.com> wrote:
>>
>> >
>> > My humble prediction
>> > Open descending and/or thoracoabdominal aortic aneurysm surgery is destined
>> > to the same fate as open gastric surgery or open gallbladder surgery within
>> > the next 10 yrs and those who don't get on board with endovascular methods
>> > will be left out.
>> >
>> > Tom Martin
>> > U of Florida
>> > Gainesville
>> >
>> > -----Original Message-----
>> > From: Igor Rudez <rudi at kbd.hr>
>> > To: OpenHeart-L at lists.hsforum.com
>> > Sent: Sat, Oct 31, 2009 6:31 pm
>> > Subject: RE: [HSF] Changing field in Our specialty
>> >
>> >
>> >
>> > Zhou,
>> > partially agree with you! Of course we have to master those (new) skills
>> > s well, but do not be afraid we are going to lose patients!
>> > can remember many of our colleagues were convinced that we're going to be
>> > ut of job because of drug eluting stents! And what happened?
>> > o, OK, yes, master the skills but no, we are still far, far in front of
>> > hem! And when they make a hole pushing some device, stent, whatever in the
>> > eart, aorta, wherever, who do you think they are going to call?
>> > Igor
>> > -----Original Message-----
>> > rom: openheart-l-bounces at lists.hsforum.com
>> > mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Zhandong Zhou
>> > ent: Saturday, October 31, 2009 7:02 PM
>> > o: OpenHeart-L at lists.hsforum.com
>> > ubject: [HSF] Changing field in Our specialty
>> >
>> > o all,
>> > I am in DC for a endovascular course for thoracic aneurysm. Only 25%
>> > re CV surgeons. Others are vascular, radiology, cardiologist.
>> > We need to catch up, without these skills, we are going to lose the
>> > ercutaneous valve.
>> > Any thoughts?
>> > Z Zhou
>> >
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-- 
Prasanna Simha M