Now open access PDF. We need to tighten up our statistical arguments in cardiac surgery if we are to make bold statements about new techniques. Industry sponsored observational studies written by authors with COI and promoted by podium presentations is not good science.

You must have had the privilege over those past 25 years of working with exceptional surgeons who make a CABG look simple. It isn’t.

Maybe I am naive and not a deep thinker, but I am not worried one bit about AI claiming my cardiac surgery job or that of the generation that follows me. I am extremely worried, however, about the dismantling of the standards that lead to credentialing and promotion in my field.

What I still love about cardiac surgery is that incompetent surgeons cannot forever hide behind institutional volume/reputation, nepotism or other nefarious means. Their incompetence will eventually catch up with them, hopefully before they have been allowed to hurt many people.

Can you also tell other doctors to stop telling their patients that the surgeon will “crack their chest”?

I am sure AI is changing the way we practice medicine, but when it comes to assessing a heart surgeon’s skills and making a real life recommendation of their ability to do a love one’s operation, it has a very long way to go…

Isn’t current practice to graft as proximal as possible (lesion permitting) to maximize antegrade perfusion of the LAD?

Programs today are mainly judged based on work hour compliance and satisfaction surveys but have no accountability for their trainees’ initial placement and early career path. The latter is a metric of utmost importance; the relationship should not end at the graduation dinner.

The reason why valve sparing roots on patients with bicuspid aortic valves and ascending aortic aneurysms are so rare is because the root is very rarely pathologically enlarged in these patients, unlike annulo-aortic ectasia patients with AI.

It was an honor taking care of one of the premier cancer researchers of our times. Thanks for your trust in our team.

Echo (TTE and TEE) is not accurate in measuring prosthetic valve gradients in small (<23mm) valves. Measure direct puncture LV pressures after AVR and see it for yourself. The entire literature on PPM / root enlargement etc based on echo gradients is simply flawed.

Asking the anesthesiologists and the OR nurses who is the best surgeon for an operation is the only safe way to pick a surgeon. They are the only ones who can separate between who is nice, who would be fun to go out with and who can get the patient out of the OR in one piece.

The biggest professional honor for a CT surgeon is to be trusted by a colleague with their-or a loved one’s-heart. Thank you @weldeiry and best wishes for a speedy recovery and continued professional success. Millions of oncology patients need your presence way into the future.

The very first recommendation of an outside consultant asked to review a program with “poor” outcomes is to stop doing high risk cases. Doesn’t that challenge the very core of risk adjustment models as an adjudicator of quality metrics for programs or individual surgeons alike?

Due to their very design, risk models fail to capture risk factors that are not adequately represented in their denominator because of experienced surgeons’ ability to identify them and avoid the patients that carry them. Yet, they have become the de facto quality metric.

Risk aversion is an unintended consequence of outcomes reporting, but one can argue it is more detrimental to patient care than a slightly elevated O:E ratio since it spares higher risk patients from an honest assessment by their surgical consultant and a shot at an operation.

Many strategies in medical management are planned in corporate boardrooms rather than medical meetings and are based on the extent of the denominator rather than the efficacy of the intervention and the potential benefit reaped by the recipients. Afib is a typical example.

Looks like an MD lounge from the 70s without the ashtrays.

A bioprosthesis implanted on a young patient does not only expose them to the risk of a reoperation but more importantly to a second lifetime cycle of LV strain (aortic) or pulmonary hypertension (mitral) as well to development of endocarditis of the degenerated bioprosthesis.

Nothing like being greeted by this duo after a long day in the OR.

Appreciate the shout out. The only thing more interesting than the study is that it was turned down by ALL major CT surgery (and some cardiology) journals. Still found a home in a (higher impact) clinical statistical journal.