Operations looking for Indications in Cardiovascular Medicine

A shift has occurred in American medical practice, often the primary focus of the "medical machine" is to make a profit and therefore much of the current treatment and therapy in cardiovascular medicine is not always in our best interest.

There is no evidence that the use of cholesterol lowering drugs extends our lives, in fact the overall death rate from the use of "cholesterol lowering drugs" has increased the overall mortality in cardiovascular patients. Along those same lines there is no evidence that coronary bypass surgery or angioplasty with or without stenting extends the life of the cardiovascular patient, it may abort an acute event, but survival tracts the usual course of the disease.

The current therapy of the cardiovascular patient is to use statins to lower cholesterol, decrease the heart rate, if symptoms present (angina) perform an angiogram. Angioplasty or stent any lesion "they deem the culprit lesion" Add an antiplatelet drug, if angina returns, repeat angiogram, repeat angioplasty or stent, repeat scenario if necessary. Refer for surgery when unable to stent any more arteries.

Hence the problem, who is watching the cardiologists and cardiovascular surgeons if money is to be made doing procedures, and in some cases unnecessary, repetitive procedures but reimbursed by insurance companies and Medicare. As a cardiovascular surgeon and often called to the catheterization laboratory by cardiologists to review an angiogram for "an opinion" I am often bewildered that the patient has been catheterized multiple times, angioplastied multiple times and has several stents in multiple coronary arteries. What do you think? is the question most often posed to me by the cardiologist, well "I think this patient should have had bypass surgery 5 years ago after the third angioplasty" is my reply, but "how can help the patient" is what comes out of my mouth.

If we are to instill patient confidence and treat the disease at the standard of care, we must be collaborative, not "protecting our vested, like 401K, interest in the patient". In other words, get a second opinion early in the course of the disease, do not return the patient to the catheterization laboratory multiple times looking for an operation (stent or angioplasty) with minimal indications and when three vessel disease is present refer for a surgical opinion. It may be possible to operate at that point with a minimal morbidity or mortality, but often times it is not. Hence the increase in cardiac catheterization procedures and the decrease in cardiovascular surgical procedures, and shamefully, sometimes inappropriately.

A word in closing, when reviewing cases for appropriateness of care, standard of care, in cardiovascular medicine cases I often look for indications for the procedure based on symptoms, appropriateness of the procedure and most importantly collaboration between the cardiologist and cardiovascular surgeon. If I see that a cardiologist has had his "vice-grip" on a patient for several years performing what we call "outlier" procedures, the red flag is raised. If your client has had multiple procedures and without the benefit of a second opinion by a cardiologist or cardiac surgeon and incurred a major avoidable complication I would be suspect that the guidelines for the treatment of cardiovascular disease were not met.

About the Expert:

This expert is a board certified cardiovascular and thoracic surgeon with over 27 years of practice experience. He is a member of the American College of Surgeons, national, international surgical societies and a peer reviewer for two state medical boards.

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.

Cardiovascular Surgery Malpractice Case

Trasylol/Aprotinin is a drug commonly used during heart surgery; it is known to cause serious complications. These complications include kidney damage, an increased risk of a heart attack, heart failure and stroke.

Trasylol is a drug that has been on the market for 13 years and is used to control bleeding. This drug is used in as many as 1 million heart and bypass surgeries per year.

Trasylol doubles the risk of kidney damage but also increases the risk of heart attack by 48%. Heart failure risk is also increased by 109% and stroke by 181%.

Because it is given intravenously, most people do not even know that they are receiving it. Also, this drug is so bad they stopped clinical trials as complications exceeded 35%.

The New England Journal of Medicine published a study on 4,374 Heart Bypass surgery patients with regard to the use of Trasylol (Aprotinin) “The Risk Associated with Aprotinin in Cardiac Surgery”. Trasylol (Aprotinin) is Bayer's inject-able drug used to prevent excessive blood loss during surgery.

The results of the study published are:

•Use of Trasylol / Aprotinin for heart surgery to control bleeding doubles the risk of kidney damage.
•Resultant kidney damage forces an estimated 10,000 patients onto kidney dialysis each year.
•Risk of heart attack is increased 48 percent with the use of Trasylol / Aprotinin.
•Risk of heart failure is increased 109 percent with the use of Trasylol / Aprotinin.
•Risk of stroke is increased 181 percent with the use of Trasylol / Aprotinin.

FDA Issues Trasylol Warning

The FDA issued a health advisory on February 8, 2006, in which it warned the public of the increased risk of kidney failure, heart attack, and stroke in patients who were given Trasylol and undergo artery bypass graft surgery.

This study pointed out that there are two other generic drugs that are safer and less expensive than Trasylol. While Trasylol costs $1,300 per dose, generic drugs are available more cheaply. Amicar costs $11 per dose and Cyklokapron is $44 per dose.

Neither of these generic drugs was associated with the same adverse reactions that characterize Trasylol / Aprotinin.

Replacing Trasylol / Aprotinin with one of the two safe generic drugs, would:

• Prevent as many as 11,000 kidney dialysis complications per year
• Save approximately 1 billion dollars in kidney dialysis costs per year
• Reduce heart attack and kidney treatment drug costs by at least $250 million per year

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.