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J Thorac Cardiovasc Surg 2007;133:1283-1285
© 2007 The American Association for Thoracic Surgery

Evolving Technology

Discussion

Dr Craig Miller (Stanford, Calif). Thank you, Dr Gelfand and Dr Hawkins. Grayson, that was a very nice presentation that we’ve come to expect from you.

This is the third report from the Arizona Heart Institute on endovascular treatment of aortotracheal fistulas. Before you got there, there was a report in 2002 with 2 cases. In your large total experience reported this year in the Annals you had 4, and now you have taken us up to 7. You pointed out in the paper that there are 36 cases in the literature and now with 3 more additional, so 39, with an overall mortality rate of 8%, which is pretty darn good considering that a lot of these patients need reoperations and have had previous grafts and whatnot. I think that is very encouraging. The question, therefore, is not can it be done. You and others and we have shown that it can be done, but how effective and how durable is it for what can be a devastatingly bad situation? And here I think you have provided some very good news with your follow-up: 43 ± 29 months going out to 6 years, no late deaths, no late infections. It’s almost too good to believe, but it is good news and it is very promising and we look forward to more follow-up.

I would like to turn to something that you’ve already broached and that’s the legal and the ethical issues at foot here. You’ve shown us very clearly the amount of work that Dr Diethrich and the institution had to go through to get a physician-sponsored individual investigator device exemption (IDE) from the Food and Drug Administration. We have also done that, and that allowed you to treat these patients, who would otherwise not have qualified for any . . . [Full Text of this Article]

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Have we gone too far? Endovascular stent-graft repair of aortobronchial fistulas

Grayson H. Wheatley, III, Anthony Nunez, Ourania Preventza, Venkatesh G. Ramaiah, Julio A. Rodriguez-Lopez, James Williams, Dawn Olsen, and Edward B. Diethrich
J. Thorac. Cardiovasc. Surg. 2007 133: 1277-1285. [Abstract] [Full Text] [PDF]