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"Heart Surgery without the surgeon"
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This sounds like the old Alfieri repair/Alfieri stitch. Will require appropriate pt selection and risk of embolization, stenosis, and midterm to longterm failure likely higher than with suture material.
That's right. They have started to appear on our daily schedules. Was wondering how common they are at other centers. Surgeons are nervous and with due reason. Fortunately our services are still needed 👍.
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I work on the Percutaneous Aortic Valve (PARTNER) trial. Same sort of situation, catheter delivered valves going in through the groin...only heart surgeon around is watching through the glass...just in case.
Transfemoral valves are Intvl Cards given, Transapical valves are Intvl Cards and a CT Surgeon who makes the cut. All patients are intubated. It's amazing to watch.
http://clinicaltrials.gov/ct2/show/NCT00530894
D712
Transfemoral valves are Intvl Cards given, Transapical valves are Intvl Cards and a CT Surgeon who makes the cut. All patients are intubated. It's amazing to watch.
http://clinicaltrials.gov/ct2/show/NCT00530894
D712
They've been doing MitraClips in select patients for a little over a year at the community hospital here that bills itself as the place to go for heart stuff. I think they recently started doing the percutaneous aortive valves, too.
It's the future. Sucks for the surgeon though. At least we can still be a part of it providing GA and TEE.
I'm pretty sure these valves are still for clinical trials only. In the US that is. I know of a guy that does them in Colombia. Also Europe has them already.
Unless of course the TEE dude is the Cards Echo/Imaging dude...🙄
That's probably institution dependent. At ours, it's the CT anesthesiologists who are doing them.
Yep. The interventional cards guys at this hospital are involved in all sorts of clinical trials. (12 cath labs and they try to keep them running at capacity. My favorite reason they've found to cath people is a trial assessing the effect of closing PFOs on migrane headaches!)
yes we had partner trial (perc avr) going on when i was a fellow...it seemed to be more driven by the surgeon--they were the ones doing it. but i know most other places, its done in the cath lab and they use their own faculty to do the echo. worries me as a CT attending...feel like cardiac surgery is going down the drain.
Didn't cardiac attendings feel the same way 20 yrs ago when they started stenting everything they could see?
That simply delayed everyone's CABG 10 yrs.
Mark my words- as long as Americans are fat slobs expecting to live to 90, there will be money for cardiac anesthesia.
Something that's been talked about on a project I'm working on, is the "hybrid" procedure where, with a triple vessel disease, the CT Surgeon would do a LIMA to LAD and the Intvl Cardiologist will stent the RCA and Cx in same OR...
Either way, seems lots of Anesthesia still to be given...
D712
Those guys (and gal) are a bunch of beasts from the interventional cards world.......
Where I did my fellowship, the CT surgeons were working together with the cardiologists on the PARTNER valve trial. Due to personalities, the surgeons ended up doing most of the work in the cath lab with a running commentary from the cardiologists.
It seemed that the cardiologists and surgeons shared a dislike for the mitral clip, even though we had some pretty aggressive interventionalists.
Perc AVR's are experimental for now. However, there was a private cardiology group in Seattle that was gearing up for a perc AVR trial from a competing company so it is possible that Gimlets group is part of that trial. The Seattle group has neither cardiac anesthesia nor CT surg immediately available.
- pod
It seemed that the cardiologists and surgeons shared a dislike for the mitral clip, even though we had some pretty aggressive interventionalists.
Perc AVR's are experimental for now. However, there was a private cardiology group in Seattle that was gearing up for a perc AVR trial from a competing company so it is possible that Gimlets group is part of that trial. The Seattle group has neither cardiac anesthesia nor CT surg immediately available.
- pod
Ditto. (Where I did residency).
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Pod, You mean no anesthesia and surgeon available for a transfemoral cases? It's interesting how these are handled, you'd think there would be a protocol specifying CT Surgeon or Intvl Cards for these trans fem cases. Why add a variable into it, now you have two different specialties putting in trans fem valves and I wonder if there's any different success/complication rates? The Interventionalists run Partner where I am and do all cases. The head guy is pretty "famous" so maybe that's why, he runs with it.
D712
Published today in the NEJM...
Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery
http://www.nejm.org/doi/full/10.1056/NEJMoa1008232?query=TOC
Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery
http://www.nejm.org/doi/full/10.1056/NEJMoa1008232?query=TOC
Great to finally see a paper out of this long study.
Martin Leon is an Intvl Cardiologist out of CUMC, Craig Smith is CT Surgeon. It's really a combined effort between specialties.
Cool. Ealier this week I was in the OR doing a case with one of the authors named in the article. Fantastic surgeon who appreciates the skillset anesthesiologists bring to the OR when he operates.
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