Off-Pump Heart Bypass
(Courtesy of mail from Dr JB Lim)

Dear all,
I have already said that for most of the cardiac operations, the heart need to be stopped completely using a cardioplegia especially if the surgeon need to change or repair the mitral, bicuspid or aortic valves. There is no other way.
Changing pistons and valves with engines running:

But if he is just trying to repair or clear up a blocked fuel line, it is possible to do this using another temporary bypass fuel line while the engine is still running, as the blocked fuel line is taken out for cleaning or replacement. This is not a magic show, a circus act, or an aerobatic stunt that requires people to applaud or clap their hands.
Birds of the same feature:


Inside beauty, not outside:
It is the main coronary vessels which are normally blocked. This is outside (not inside) on the walls outside the heart. The main car fuel line is outside the engine, not inside the engine. The surgeon is not going to get a Nobel Prize in medicine for this by replacing a vessel outside the


Inside achievement, not outside:
If that ‘famous’ nutty surgeon who claims through his ass-hole that he can perform all those complicated internal repairs without stopping the heart, then he can shout, and shout, and we will all listen to his miracles. Then perhaps he deserves, not just one, but 10 Nobel Prizes, and we will all adore and worship him as a god. But if he was just doing a minimally invasive operation over (outside) on the walls of the heart, then he needs to be paid minimally for a relatively easy job. He can then go to the bank to fatten his account, and shut his mouth tight.

By the way, not a single Nobel Prize in Medicine or Physiology has been given to any heart surgeon so far, because there are far, far more complicated and tougher and pressing problems in health and medicine such as fighting against malnutrition, malaria, emerging infectious diseases such as tuberculosis, hepatitis, AIDS, H1N1, diabetes, high blood pressure, degenerative disorders, etc affecting millions of people.
These are the real extremely tough problems against Mother Nature we have not being able to overcome yet. These have brought untold sufferings and miseries to billions of human lives in poor and developing countries till this day. We were always discussing these real problems at scientific conferences. There don’t seem to be a solution even in the distant horizon. It fact they are getting worse even after scientists have spent hundreds of billions of US $ conducting research and studies for decades world-wide. Even WHO does not know what to do now? WHO does not know how to offer a solution for these increasing problems?

Doing ‘fantastic’ things like Fontan heart operations, heart transplants, off-pump bypass surgery, etc are very low priority to WHO and to all countries throughout the world. A heart transplant cost about RM 400,000 for each patient, and it benefit only him or her, but not the billions of people out there.


These are the patients who apparently ate a lot, overweight themselves out of control, smoke a lot, refuse to exercise, watch TV all day long on a couch, think only how to make more money, stressed out a lot on how to become richer, etc, etc. These are the patients who deserve to die early because they are very rich, care not for the hungry, the poor and deserving. They are of no use to society. It is just selfish lives.
Spending effort on wrong patients:
Neither does any heart surgeon who spends his time and effort treating these entire ‘potatoes couch’, and collect a lot of money out of them deserve any award. Pound foolish, penny wise! Robbing the poor to pay the rich!
The same as with space-circus act:

Find a ‘cure’ for ‘simple’ diseases first:
If a scientist can find a permanent cure for cancer, for cardiovascular diseases, for all the emerging infectious diseases I listed above once and for all, diseases that afflict hundreds of millions of people every year, costing untold economic and social losses, and untold miseries – all these pressing diseases we are fighting a losing battle against Mother Nature.
If any scientist can do that, we will all bow down to worship him, and the Swedish Academy will instantly give this medical scientist 10 Nobel Prizes. It will be a real medical achievement. We in the medical research professions and the Ministry of Health have been discussing these problems among the best experts and brains for years at countless meetings, national and international conferences until all of us retired without an answer.
Doing ‘fantastic’ thing like off-pump CABG (OPCAB) to benefit only the rich who eats a lot, overweight, cannot learn to relax or wanting to find spiritual inward peace for himself, and paying RM 50 000 (perhaps) each time to the surgeon and the hospital and the drug companies for them to drain away the bank savings of the ‘victim’ is of no use to anybody. In any case the maximum human life span is just 120 years no matter what we try to do.
That surgeon has not solved any problem for humanity. He has only increased the miseries, the hunger, the poverty and the squalor of millions out there in poor and deprived countries – especially the children who don’t even have a meal a day. He is not going to get any Nobel Prize for doing OPCAB for sure. The Swedish Academy does not think so. .
Prioritize if they want an Award:

No wonder all the Nobel Prizes in Medicine or Physiology were, are, and will continue to be given to scientists whose discoveries are going to benefit the billions out there. It is not going to be easy. It is not going to be given to a car mechanic or a heart surgeon who can do circus act of repairing from outside without stopping the engine. That’s for sure!

Sorry!
JB Lim


Labels: The Thoughts of Dr JB Lim
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