Batista Opportunity, philosophy

  Name: Jean Durand
  E-Mail: ***@****
  Subject: Batista : Opportunity, philosophy
  Body of Message:
  25 April 1998
  Hi !
  I address to you to ask a question you concerning Batista. (Would you
  excuse my very bad english, please, I am French)
  I am a man of 55 years, 179 cm, 78 Kg. In March 1997, I have
  made a serious pulmonary oedema. In reanimation, one discovers while I
  had a dilated cardiomyopathy severe (mass index=278/m2) with a fraction
  of ejection (FE) < 15 %. Right cavities are normal. NYHA class 2+ or 3.
  Unknown origin but very derogatory prognosis from my doctors that
  recommend
  an urgent transplant.
  Processing : AEC, beta-bloker, diuretic, potassium, many anti-arythmics
  to cause of my officials extra-systols. Problems of low tension and
  fibrillation.
  Examinations of meadow-transplant to the hospital : left ventricle in
  very bad state, FE = 19 %, excellent arteries including coronarys,
  technically possible transplant.
  Two month later, improvements, less of breathlessness, progressive
  disappearance of extra - systols, fraction of ejection = 33 %, Peak VO2
  (ml/min/kg) = 21. Excellent processing !
  I am put on a waiting list but one no longer speaks urgent transplant.
  One waits that my state degrades to intervene. Obviously since, I have
  informed on success and failure statistics of the transplants as well as
  on continuations. Furthermore, I am come across the numerous articles
  that figure on Internet concerning Batista.
  To priori, I would be very favorable to this intervention : less heavy,
  choice of the day and the surgeon and especially no problem of reject.
  But I know also that one lacks recession, that a lot consider that one
  is again to an experimental stage and that this is not again an
  alternative to a transplant.
  I know that it is very difficult for you to give me an advice without
  to know my file. Nevertheless, could have you to give me your opinion on
  next points :
  - It seems that more one is young and in good condition, best are the
  odds of success., Statistics (contradictory) concerning Batista show
  all, for example, that stages III have best results that stages IV.
  -Personne not believing to a real improvement of my heart, why to wait
  a gradation that will decrease my chance of success ? Today, I am to a
  stage between I and II. Think you what it is preferable to wait ?
  -What are risks of mortality to the hospital after a Batista for a
  population as mine ?
  -Do you know a competent European team on Batista ? Or well do you think
  that it is preferable to be made operate in the United States ?
  
  Whole this puts elsewhere a philosophical problem. It seems that one
  waits always that the state of a patient degrades to recommend an
  intervention. The cardiologists tell that it does not is necessary to
  intervene when odds of survivings are superior those after operation.
  This appears me erroneous for the next reasons :
  The majority of the serious cardiopathies never improve but degrade with
  the time. Since an intervention will be a safe necessary day die
  preliminary, why to wait that the state degrades to intervene, when odds
  of success will be less good ?
  It is paradoxical, especially for Batista that provokes no phenomenon of
  reject !
  I think that a lot cardiac pose the same question that me. Your
  reputation is very important and your competence is recognized
  universally. Would have you the amiability to reply me or to indicate
  me an address internet or a book who speaks these problems ?
  In advance, thank you very much. And please to excuse my very
  approximate English.
  ***@****

[CCF Cardio MD-SGM]

_
M. Durand,
Je comprends le fran