Cardiac Outcomes

Alice Parkreviews David Jones' counter intuitive newbook on the history of cardiac surgery and coronary angioplasty in most recent issue of Harvard magazine.  Jones, also a physician, is a professor of medical history at Harvard.  His latest book explores the rise of interventional cardiology and cardiac surgery since the 60's and how much of the rationale for such a procedure-dominated treatment strategy is undergirded by some surprisingly shoddy data. The first randomized clinical trial of bypass surgery ’s efficacy, using data from a collaboration of Veterans Administration hospitals, was not published until 1977. Such trials were then becoming the gold standard of medical research (and still are). “Surgeons said trials were totally unnecessary, as the logic of the procedure was self-evident, ” says Jones. “You have a plugged vessel, you bypass the plug, you fix the problem, end of story.” But the 1977 paper showed no survival benefit in most patients who had undergone bypass surgery, as compared with others who’d received conservative treatment with medication. It's funny, coming from the perspective of surgical training, I don't recall ever hearing from disgruntled cardiac surgeons the actual reasons why bypass surgery had started to fall out of favor during the nineties and oughts.  All I heard was that fellows were having a hard time scoring jobs because bastard cardiologists were snaking all the cases.  Nev...
Source: Buckeye Surgeon - Category: Surgery Authors: Source Type: blogs