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

John Schor johnschor at mac.com
Sun Nov 1 06:06:12 EST 2009 

Agree with Ani, and that's why I am in the game.
John Schor, MD
Thoracic and Cardiovascular Surgery
Heart and Vascular Center of
Northern Arizona
Flagstaff, Sedona, and
Cottonwood, AZ
Tel: 928-649-2584

On Nov 1, 2009, at 5:20 AM, Ani Anyanwu 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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