About Cardiovascular Surgery WEB

This site is made to provide information of cardiovascular surgery for patients or general physicians.

We try to explain it with plain expression. However, we try to provide new or cutting-edge information using pictures of real surgery, and we believe it useful for cardiologists as well.

Since medical science is rapidly progressing, new and high-quality information often helps patients in the field of cardiovascular surgery, too. For instance, 1. some patient who is in dangerous situation but believes that he/she is OK just because he/she does not have too much pain often loses the best timing of treatment, 2. Some other patient who has chance to be cured by the treatment, but gives up his/her future by misunderstanding the situation; these patients may hopefully be cured by the information in this WEB.

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About background knowledge

For patients or their family, explanation of background knowledge or terminology may be not enough. However, we made this WEB site, assuming that the patient already heard explanations about his/her diseases from the doctor. In other words, we tried not to make the explanation too long.

In the field of cardiovascular surgery as well as other many fields, so-called ranking-book or introduction of great doctors/super-doctors are often informative. However, the books usually do not carry specific information of treatment. Thus, this WEB may be useful to read the above type of books.

We plan to divide the WEB to patients' pages and doctors' ones in the future. The photo gallery is  made for change of air and is the author's hobby. List of papers is made mainly for doctors so that they can have more accurate and detailed information.

                                                                                                                                 

EBM, its great merits and weak points

   Importance and usefulness of EBM (Evidence Based Medicine) is well recognized from more than 20 years ago. It is good to have many guide lines which is based on EBM. In this WEB, we describe information by considering EBM.

Recently, however, limitation of EBM has been recognized.

For example, prospective and randomized clinical study which is most useful study for EBM is difficult for emergency or very sick patients, because of ethical reasons or restriction of time.  In other words, EBM has a weak point of data set based on good-risk patients.

This type of information is well known among the doctors who have worked in American or European university hospitals which have excellent clinical research program based on large volume of cases. In Japan, however, university hospitals usually have small number of cases and clinical research is not well extablished, and the above limitations of EBM is not necessarily well understood.

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Cardiovascular Surgery and EBM

Take Off-Pump CABG (OPCAB) for example, we believe that the OPCAB is saving many patients with severe general atherosclerosis who often had not been saved in the past. Such patients, however, are very difficult to be randomized. We believe it one of the reasons why advantages of OPCAB over on-pump CABG had not been proven so far. We think it a good example of limitation of EBM.

Believing the strong clinical impressions that OPCAB can save many sick patients who had not been good surgical candidate, many experienced surgeons do OPCAB with confidence and belief.

Similar thing can be said for valvular heart disease, arrhythmia surgery, LV restoration surgery, or Aortic arch surgery.

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Database may evaluate clinical practice properly

Recently, whole-Japan database is established, and now we can compare our own results with expected results. European and American database are also available for the same purpose.

Such information will be more important and useful from now.

For example, if we lose some % of patients after the surgery, we always regret and feel sad/sorry for the patients. But, using the database, results of the same patient in good average hospital in this country can be calculated, and if its mortality is higher than ours, we can say that we relatively did a good job, even if not satisfactory.

This type of common-sense in the world is not always well understood in this country. We describe the informaton in the WEB considering the above situation.

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What type of contributions can Internet make?

There should be various merits obtained from Internet. I believe that 3rd party or objective information provided by Internet can be helpful. Patients often feel difficulty in asking too many questions to doctors, even if dorcotr try to help patients.

Patients' mind often becomes unstable. A patient said that he can tell something to house-keepers that cannot be told to doctors or nurses. I felt that we have to make more efforts of ice-breaking and relaxed atomosphere.

Of course Internet has its weakness such as one-way informaton or lack of some points that may induce misunderstanding. Thus I recommned patients to check other information, starting from the information here, and to ask questions to doctors toward satisfactory decision.

When we discuss medicine or medical practice, general knowledge in the textbook is essential. But, knowledges and techniques based on the real-world experiences, espiecially first-hand information is also important.

From the viewpoint, in this WEB we describe first-hand information as well as policy and belief which stemmed from the actual experiences.

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Asking

Good WEB site grows mature by means of bi-directional communication.

We ask readers of this WEB to send us opinions or questions. We will answer as much as possible.

　　　　　　　　　　　　　                    Authors