Heart Expelled Through Chest Wall, Sternotomy Disaster

[Birdstrike]

I like how the surgeon called the wife to his office…

…to blame someone else for his catastrophic error. Disgusting, pathetic, appalling and cowardly move.

But it doesn’t surprise me, because someone did something similar to me.

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[southerndoc]

Does umbrella insurance cover excess for malpractice?

It never covers professional malpractice. That is a very important point about anyone who gets umbrella insurance. Umbrella insurance is to cover claims that exceed your homeowner's, car, etc. or for personal liability (i.e., you're walking down the street and accidentally trip someone). It's wise to have it with physician income levels, but it's not designed for and will not cover professional malpractice claims.

Many CMGs, maybe SDGs, and malpractice insurers have supplemental policies that cover above malpractice insurance policy limits. This is not well advertised nor should it be.

 

[Robotic Wis-Hipple]

CABG is hugely invasive but the surgery works well. Having had a family member go through it, it is an impressive medical feat.

The pathology report is interesting. Cardiac surgeon recommended 4 vessel CABG. Pathology report mentions two grafts only. Patients IMA is missing but not grafted.

Bad case. You have a dehiscence and then leave town. Optics are not good. Why couldn't the other cardiac surgeon take him back for the closure? If you are sharing call, that comes with the territory.

I have taken back other people's complications back when taking call. It's not ideal but what can you do?. Liability is always an issue but can't just let the patient suffer.

Regarding the difference between recommended grafts and actually performed grafts;

This happens occasionally. Maybe IMA taken down but was a puny vessel, or had significant calcium/disease, or was injured during takedown. Multiple reasons an IMA may not be used.

Why from 4–>2 grafts? Poor targets for implant grafting in the other two, small native vessel, or…. Not enough vein harvested as they planned on using an IMA that they then had to use vein to graft the LAD with.

The fact that CABG surgery has become so routine and outcomes are so good is literally amazing.

 

[TooMuchResearch]

Just start taking Repatha

Yeah, this is what I'm wondering...did anyone check his LP(a), are they following Apo B to see if there is actually appropriate response to treatment. We have ways to treat these things, even if the patient is doing what they need to do.

 

[anonperson]

Regarding the difference between recommended grafts and actually performed grafts;

This happens occasionally. Maybe IMA taken down but was a puny vessel, or had significant calcium/disease, or was injured during takedown. Multiple reasons an IMA may not be used.

Why from 4–>2 grafts? Poor targets for implant grafting in the other two, small native vessel, or…. Not enough vein harvested as they planned on using an IMA that they then had to use vein to graft the LAD with.

The fact that CABG surgery has become so routine and outcomes are so good is literally amazing.

Good information.

Just looks bad from the surgeon side. Doesn't even end up using the IMA. Sternotomy dehiscence. Waits on repair etc.

Paints the picture of a sloppy/sub optimal surgery and surgeon.

Every Mal practice lawyers dream

 

[VA Hopeful Dr]

Yeah, this is what I'm wondering...did anyone check his LP(a), are they following Apo B to see if there is actually appropriate response to treatment. We have ways to treat these things, even if the patient is doing what they need to do.

My understanding is the data behind those numbers as far as treatment goes isn't really there yet.

 

[TooMuchResearch]

My understanding is the data behind those numbers as far as treatment goes isn't really there yet.

Peter Attia drive #210 was a good interview and all about LP(a). The tl;dr is basically if LP(a) is elevated, best you can do is aggressively manage lifestyle and add meds, probably PCSK9 inhibitors. Though there are other things in the pipeline. It costs about $30 to check LP(a) and at minimum provides some insight into the patient's risk profile. I think it's worth it. I'm also an emergency physician and obviously don't manage this stuff.

 

[VA Hopeful Dr]

Peter Attia drive #210 was a good interview and all about LP(a). The tl;dr is basically if LP(a) is elevated, best you can do is aggressively manage lifestyle and add meds, probably PCSK9 inhibitors. Though there are other things in the pipeline. It costs about $30 to check LP(a) and at minimum provides some insight into the patient's risk profile. I think it's worth it. I'm also an emergency physician and obviously don't manage this stuff.

Its one of the elements of those advanced lipid profiles which have been around since I was a resident.

Its definitely been associated with increased risk of CV problems but there has yet to be a study that shows treatment directed at that makes a difference in outcomes as far as I am aware.

We played a similar game with HDL years ago and gave lots of people niacin to no benefit.

I don't do this myself, but I do know doctors who will test for it and use it to encourage patients who don't want to treat their cholesterol to take a statin.

 

[Beeftenderloin]

Yeah, this is what I'm wondering...did anyone check his LP(a), are they following Apo B to see if there is actually appropriate response to treatment. We have ways to treat these things, even if the patient is doing what they need to do.

My understanding is the data behind those numbers as far as treatment goes isn't really there yet.

CABG, on the other hand, is one of the most well studied, well validated surgical interventions in existence, and although invasive, provides a durable mortality benefit 10 years out (when compared to PCI in patients with LM dx, triple vessel, multi-vessel with DM, or multi-vessel with HFrEF). The patient came in needing 4 grafts, so unless they had some otherwise unstated feature that made them prohibitively high risk (poor targets, porcelain aorta, prohibitively high BMI, etc) it sounds like they were appropriately selected for surgery. The surgeon on the other hand…

 

[ShockIndex]

…to blame someone else for his catastrophic error. Disgusting, pathetic, appalling and cowardly move.

But it doesn’t surprise me, because someone did something similar to me.

When the patient is crumping, the ABCs of the CVICU where we co-manage the patients with CT surgery are:

Albumin
Bicarb
Calcium

After the patient dies, the ABCs become:

Accuse
Blame
Criticize