It figures. I head out of town and the cardiovascular news world erupts:
Dick Cheney gets a heart transplant
This was pretty predictable: after all, he's had every other known cardiovascular therapy known to man and had done remarkably well with all of them. I heard Mr. Cheney speak years ago when he gave the keynote address to the American College of Cardiology when I was indoctrinated as a Fellow in the College. He was a man profoundly affected by the cardiovascular disease, watching his father die at a young age following a massive myocardial infarction treated only with morphine sulfate. He, in contrast, repeatedly benefitted from the phenomenal innovation explosion within our field: he had successful bypass surgery on several occassions, treatment with an implantable cardiac defibrillator, left ventricular assist device - and now - transplant at the age of 71. Old? Certainly. Unheard of? Certainly not. How he'll fare through his last surgical ordeal, one fraught with the added challenges of immunosuppression, remains to be seen.
First-hand Account of the Department of Justice's Investigation on ICD Use Published
I had my say on this and the challenges doctors experience when seeing patients that fall outside of payment criteria for defibrillators but meet professional guideline requirments. (Managed to finalize my edits before boarding my plane!) But with this ongoing paradigm for medical device usage, I continue to wonder what recourse physicians will have when additional inconsistencies are noted between CMS coverage decisions and professional guidelines for all specialties in the years ahead.
Report of Deaths from St. Jude's Riata Lead are Published
I suppose this was really not that surprising, but what was surprising is that St. Jude did not come forth with these findings - only a post hoc analysis of the FDA's MAUDE database by the Robert Hauser, MD and his group from the Minnesota Heart Institute was again necessary. We also see the results of the Vanderbilt groups' fluoroscopic analysis of the Riata leads come to light as well. The implications for managing patients with these leads are significant, especially since the high voltage leads within the Riata lead appear to fail. Most are in agreement that routine extraction of these leads should be avoided. How to handle monitoring of the high voltage portion of these leads remains of concern. While doctors have gotten pretty good at handling these issues, there is no question that the Riata lead fiasco offers new challenges clinically.
So there you have it. My brief summary of the big cardiovascular stories for the past week. While I'm looking forward to re-entering the blog-o-sphere next week, I must say the break from the electronic world with my family has been VERY nice.