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How to Overcome HCD in Shared Decision Making for Valve Surgery
Barbara L. Robinson.
East Carolina Heart Institute, Greenville, NC, USA.

OBJECTIVE: Health care disparities have been magnified over the last year. One areas of HCD not discussed is the consent process for surgery.
METHODS: In the stated valve guidelines shared decision should occur.hhh
RESULTS: This is the case of a 57 year old hypertensive, diabetic, obese, black female with a recent prior stroke, in chronic pain on chronic narcotics also with a history of medication non-compliance, with severe aortic valve regurgitation. The attending Dr. MW booked the patient for a mechanical AVR via full sternotomy. No offer was made for a tissue valve of any type, nor minimally invasive approach. No current inhouse echo was obtained. Only pullback was performed at the time of the coronary catheterization with no aortic root shot. The last echo obtained was nine months ago, was an outside echo and was not looked at by the attending MW.
CONCLUSIONS: In conclusion this poor obese non compliant black female on chronic narcotics with prior stroke, was only offered a mechanical valve via full sternotomy. Despite the long term national trend towards tissue valves over the last 20 years and her risk factors no tissue valve option was presented. She did not benefit from shared decision making. Further refinement of guidelines, while intuitive, require looking at current imaging prior to patient counseling and booking a case.This is only ethical and in accordance withe rhe hipocratic oath we all swore to and the significance of donning the white coat daily.


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