“ I really do think that ultimately for bad multi-vessel disease it boils down to a matter of plumbing -- how many open conduits do you have? And it’s going to be pretty hard to beat surgery in this regard.”
But this rate of first-operation mortality for bypass, in the peri-1%, that's not so unusual these days, is it?
For patients who qualify for PCI, it isn’t that much of a surprise. I'll bet if you look at the Cleveland Clinic, at patients like this, it's considerably less than 1%. So I don't think the trial is totally a fluke.
SoS included a prospective assessment on congnitive function.
Some have discounted surgery's success in the trial because of “pump head.” (The patients are alive but their brain isn’t working.)
Cognitive decline with CABG Percentage of patients suffering decline in cognitive function by > 20% post-CABG compared to pre-CABG baseline At 5 years At discharge Newman et al. N Engl J Med 2001; 344: 395-402. 53% At 6 weeks 36% 24% 42% At 6 months SoS
“ It seems to me that ultimately the two procedures need to be combined. That there are probably some vessels within a patient that would do just as well with a stent, and there are others that perhaps are ideal for off-pump bypass. And that somehow combining those two, you ought to be able to get the best of both worlds.”
“ In the best of all worlds it would be nice to have an independent opinion. Ideally, it would be nice if you had this really proficient angiographer who didn't necessarily do interventions, or would be able to review a cath without a bias, to be the honest broker to make decisions. But we don't have that.”