Thursday, August 27, 2009

Something to Think About

Hello all,

This is my first post here, so I hope I don't completely bore everybody to tears. Anyway, in my day job, I write and edit a lot of news items specifically aimed at doctors--cardiologists to be exact. I ran across something last week that actually seemed of interest to normal people.

The story involves a new, cutting edge procedure to replace the aortic valve, which is the valve in your heart that allows blood to flow through the aorta and to the rest of your body. As we (and I'm using the royal "we," of course) get older, the aortic valve can get all gunked up and become too narrow, obstructing blood flow.

This can lead to some serious problems like heart failure, and is not that uncommon in the elderly. This new procedure involves a neat little device that consists of a tiny expandable piece of mesh wire inside a replacement valve. You thread the little device on a wire through an artery in the groin up into the heart, inside the gunked up valve, expand it, pushing the old valve out of the way. Voila! New valve. No more open chest surgery, faster recovery, fantastic.

Except that this is at the very early stages. It hasn't been approved in this country outside of clinical trials, and there's a real learning curve, and as a patient, you don't want to be on the wrong end of it. The doctors who are pioneering this procedure are the interventional cardiologists, the guys who put stents in coronary arteries during angioplasty. The doctors who this procedure would put out of business are the cardiac surgeons, who do all the open-chest heart operations.

When one of these cases comes along, guess which two types of doctors have to collaborate? The story I wrote shows how the opinions of these two groups of doctors differ over this procedure. As you might expect, the surgeons emphasize the negative aspects of it and the cardiologists emphasize the benefits. What was interesting was that it didn't even matter how much experience they actually had with the procedure. Just being a cardiologist or a surgeon determined how they viewed it.

So what does this mean to normal people? I can tell you that I just happen to have a defect in my aortic valve, and while it doesn't require replacing today, it most probably will in 20 years or so. And what will I do if I'm consulting with my crack medical team, which consists of my primary care guy as well as my surgeon and my cardiologist?

I will educate myself, big time. I'll find out how many procedures these guys have done, what's their complication rate, what's the complication rate at their hospital? What hospital has the lowest complication rates? How does this compare to complication rates with normal open surgery? And what about afterward? What's the durability? Will I just be back for another procedure in a year? What if I don't do anything? What are the rates of complications in people my age with my condition who just take medication?

You get my drift. It seems like a lot, but when you've got doctors who can't agree among themselves, there's no one else. Just you. Or in my case, me. And I'm sure there are many others in the same boat. Anyway, just something to think about.

No comments: