New technique for ascending aorta

[Patsman07]

http://www.exstent.com

Just found this on tedtalk. Doesn't mention if its suitable for people with valve problems. But I can't see why it wouldn't work with a valve repair. Unfortunately too late for me, had bental procedure 2 and a half weeks ago.

 

[pellicle]

love Ted talks

thanks for sharing this one ... very interesting

 

[pellicle]

thanks for sharing this one ... very interesting

now that I've had time to watch it and assemble my thoughts I have some 'review' of that video

The Good:
the idea of being able to simply sock and support the aorta is an excellent one. That one can have ascending aorta supported without valve replacement (should valve replacement not be needed) is great.

However I wonder (for us valvers) how often that actually is? The fellow giving the Talk (Tal Godsworthy?) has Marfans syndrome, which is of course different to those of us who have BAV which seems to lead to dilation of the ascending aorta in many of us. So our situations are different.

the bad:
I discovered on careful listening that he starts out with this shock horror story of having his chest opened up (appeal to the hysteria). He uses appeal to emotion (horror) in his description of the 'on offer' treatment with the anesthetize you, open your chest put you on an artificial heart lung machine .... but then when he describes his own procedure he says "installation is quite easy" ... yet it still requires his chest be opened up (and I hope he was anesthetized for that).

True you do save your own aorta and do not compromise the vascular system, which is great.

His description of "replace it with a plastic valve and a plastic aorta" is also to me quite wrong.

I noted that on his slide the antibiotic therapy is NO .. hmm ... I have my own opinion of the benefits of that (considering the real risks of antibiotics are minimal with people seeking them for a cold even) and in fact he tries to make his chart longer but in fact has just three really good points on his chart (which are good points!!)

Then he also talks about warfarin as if its mandatory, which is not my understanding. I would be pleased if anyone can actually set me straight here, but it was my understanding that ascending aorta could be grafted without you being on warfarin. I assumed that (for instance) even if the valve had to be replaced (and does it?) a tissue valve could be used and thus his having to be on warfarin is a bit of a skeleton rattle.

Next he says that while the thought of the surgery was not attractive, he somehow puts the thought of the warfarin as "really quite frightening" and goes on to make completely wrong (sadly common) misrepresentations on how it will "shorten your life". This is of course more of an appeal to emotion (again) and not supported by many facts.

one more hammer for the anticoagulation therapy at the end (clearly he has a horror of that). He adds that "if you speak to people who are on long term warfarin it is a serious compromise to your quality of life". Where he gets the "it inevitably foreshortens your life" from I'm just not sure.

Strangely we just don't find that in our group. The majority here who are on long term warfarin do not say its a serious compromise ... wonder who he spoke to?

So, all in all very interesting but quite a bit beneath the levels I have come to expect in TED talks.

Ultimately I think its a great tool to add to the repertoire of surgery and I hope it goes somewhere (despite the obvious conservative barriers). For those who need aortic graft and don't need a valve replacement I really do hope it gets mainstream.

 

[Patsman07]

now that I've had time to watch it and assemble my thoughts I have some 'review' of that video

The Good:
the idea of being able to simply sock and support the aorta is an excellent one. That one can have ascending aorta supported without valve replacement (should valve replacement not be needed) is great.

However I wonder (for us valvers) how often that actually is? The fellow giving the Talk (Tal Godsworthy?) has Marfans syndrome, which is of course different to those of us who have BAV which seems to lead to dilation of the ascending aorta in many of us. So our situations are different.

the bad:
I discovered on careful listening that he starts out with this shock horror story of having his chest opened up (appeal to the hysteria). He uses appeal to emotion (horror) in his description of the 'on offer' treatment with the anesthetize you, open your chest put you on an artificial heart lung machine .... but then when he describes his own procedure he says "installation is quite easy" ... yet it still requires his chest be opened up (and I hope he was anesthetized for that).

True you do save your own aorta and do not compromise the vascular system, which is great.

His description of "replace it with a plastic valve and a plastic aorta" is also to me quite wrong.

I noted that on his slide the antibiotic therapy is NO .. hmm ... I have my own opinion of the benefits of that (considering the real risks of antibiotics are minimal with people seeking them for a cold even) and in fact he tries to make his chart longer but in fact has just three really good points on his chart (which are good points!!)

Then he also talks about warfarin as if its mandatory, which is not my understanding. I would be pleased if anyone can actually set me straight here, but it was my understanding that ascending aorta could be grafted without you being on warfarin. I assumed that (for instance) even if the valve had to be replaced (and does it?) a tissue valve could be used and thus his having to be on warfarin is a bit of a skeleton rattle.

Next he says that while the thought of the surgery was not attractive, he somehow puts the thought of the warfarin as "really quite frightening" and goes on to make completely wrong (sadly common) misrepresentations on how it will "shorten your life". This is of course more of an appeal to emotion (again) and not supported by many facts.

one more hammer for the anticoagulation therapy at the end (clearly he has a horror of that). He adds that "if you speak to people who are on long term warfarin it is a serious compromise to your quality of life". Where he gets the "it inevitably foreshortens your life" from I'm just not sure.

Strangely we just don't find that in our group. The majority here who are on long term warfarin do not say its a serious compromise ... wonder who he spoke to?

So, all in all very interesting but quite a bit beneath the levels I have come to expect in TED talks.

Ultimately I think its a great tool to add to the repertoire of surgery and I hope it goes somewhere (despite the obvious conservative barriers). For those who need aortic graft and don't need a valve replacement I really do hope it gets mainstream.

An excellent critical analysis!

 

[river-wear]

Very good, pellicle! I had seen the video some time ago - my husband sent it to me prior to surgery - and even then I balked at his characterization of warfarin. It's a pity he felt the need to add drama to what would have been a good video anyway.

I'll have to watch it again to remember why his invention is supposed to be better than established valve-sparing aneurysm surgeries that have been out there much longer. I was always under the impression that a graft didn't require ACT as you noted.

 

[pellicle]

Hi

VIt's a pity he felt the need to add drama to what would have been a good video anyway.

exactly! Anyway I think the invention is an excellent idea and I hope it gets wider acceptance.

I'll have to watch it again to remember why his invention is supposed to be better than established valve-sparing aneurysm surgeries that have been out there much longer.

I'm guessing its because the artery is not actually cut into and the heart stopped. To me those two points are really big ones and deserve credit.

I think he also made some good points about
* the resistance of the medical fraternity to new ideas and
* the reduced costs in development

however I have a friend who once worked for Cook Medical (making catheters) and there are of course many other issues which that presentation glossed over in the reality of making things for surgery and the whole costs of development. He made it sound like "do some scans and whack it on a 3D printer". Perhaps with *that one idea* yes, but what should the companies do about funding the development ideas which were stopped by other issues? Sure his was not a dead end, but if it had been (for some obscure reasons) then he'd have blown his investment and if he was a business be bankrupt.

 

[river-wear]

Avoiding bypass is definitely an improvement. That should virtually eliminate the risk of stroke.

Here's an article I found after initially watching the video that I thought was interesting:
http://www.cleveland.com/healthfit/index.ssf/2012/03/3-d_printers_help_doctors_cust.html
And a more recent one with more info:
http://www.qmed.com/mpmn/medtechpulse/new-dimension-3-d-printing-modeling-aneurysms

 

[pellicle]

Avoiding bypass is definitely an improvement. That should virtually eliminate the risk of stroke.

definitely!

Here's an article I found after initially watching the video that I thought was interesting:
...And a more recent one with more info:
http://www.qmed.com/mpmn/medtechpulse/new-dimension-3-d-printing-modeling-aneurysms

the second was the most interesting to me, although the first one has been on my mind since I saw the first cellular colonization of tissue a few years ago. Very promising.

Speaking as one who's likely missed that boat I wonder if the disease and pain free future will make people better people or if the path we've walked has made us better (and if that even matters).