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J Thorac Cardiovasc Surg 2006;131:261-263
© 2006 The American Association for Thoracic Surgery

Editorial

Device discordancy: Lost cords, quick-fix seekers, quality, and ethics

Center for Aortic Surgery, Marfan Syndrome and Connective Tissue Disorders Clinic, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication October 4, 2005; accepted for publication October 10, 2005.

^_* Address for reprints: Lars G. Svensson, MD, PhD, The Cleveland Clinic Foundation, 9500 Euclid Ave/Desk F25, Cleveland, OH 44195. (Email: svenssl@ccf.org).

The first 20% of the full text of this article appears below.

Our modern world is so accustomed to instant gratification and efficiency with the accompanying expectations of little effort or pain that people will often choose the easy path at the cost of a poorer outcome over the long term. There are many examples of these choices by both consumers and patients, particularly when they are not fully informed, including use of catheter-based devices rather than open procedures.

In this issue of the Journal, Flores and colleagues ¹ present their experience with combined open aortic arch repair and descending thoracic aortic stenting in the hopes of avoiding a second procedure, either open or endovascular, to treat patients more speedily. The results are sobering. First, their circulatory arrest times must have been prolonged, thus risking greater brain injury to the patients. Second, postoperative spinal cord injury occurred at an unacceptably high percentage of 24%. The finding of an increased complication rate of spinal cord injury is not new. For example, acute aortic dissection repair with replacement of the entire aortic arch (a questionable procedure except in rare cases) and stenting of the descending aorta has resulted in a similarly high rate of lost spinal cord function. ^2-7 Furthermore, in our early experience with the modified inverted elephant trunk insertion method in 84 patients, ⁸ we noted that too long of an elephant trunk graft in the descending aorta resulted in complete paraplegia in 1 patient and paraparesis in 2 patients. This led to our recommendation that an elephant trunk graft should be no longer than 10 to . . . [Full Text of this Article]

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