Interview With Marc Ruel: Thoughts on Minimally Invasive Cardiac Surgery and the MIST Trial
Bibliographic record
Abstract
Om Prakesh Yadava, of the National Heart Institute in New Delhi, India, interviews Marc Ruel of the University of Ottawa in Canada. Drs Yadava and Ruel discuss minimally invasive cardiac surgery (MICS), its benefit in both the developing and developed world, and the MIST (minimally invasive versus sternotomy) trial. Dr Marc Ruel feels that cardiac surgery, being a reconstructive and not an ablative specialty, was slow in developing MICS but that it is now on track as even developing countries like India have taken to it with gusto. He encourages collaboration between the developing and developed world. Taking a cue from a recent editorial by Kappetein and Vahanian [1], Dr Ruel discusses the terms, "efficacy" and "effectiveness," where efficacy refers to controlled conditions and effectiveness refers to real life and unmonitored situations. He comments that although MICS is definitely efficacious, effectiveness has yet to be proven. He stresses that specialized centers should be developed and that these procedures should be done, at least at this stage, in those specialized centers.Dr Yadava asks whether these technologies are relevant to a developing country such as India, given that science must answer to the aspirations of the society and considering the different contexts of cost containment in the western world and India. Dr Ruel responded that these surgeries are all the more important to a developing country like India, as the medical and social networks are not as strong as in other countries and therefore, patients need to get back to work faster. This is one major advantage of MICS: shorter convalescence and early return to gainful employment. Dr Ruel feels that MICS helps society and is therefore relevant to the developing world. Mechanical circulatory support devices and transplantation impact an individual or a family and might even help in the branding of an institution, but they do not produce great benefits to the society at large. Minimally invasive techniques, however, are very relevant to the community and society, especially in the field of coronary artery disease, which is rampant in Southeast Asia.Dr Ruel then discusses the rationale, inclusion and exclusion criteria, and the primary and secondary end points of the MIST trial. He also discusses the methodology being adopted for the trial, which compares the minimally invasive approach with sternotomy for coronary artery disease. Dr Ruel is the principal investigator of this multicenter international randomized controlled trial. He states that though there is some level of observational data, there is no randomized controlled trial comparing these two approaches to surgically treating coronary artery disease. The MIST trial aims to bridge that gap.ReferenceKappetein AP, Vahanian A. Effectiveness in a real-world observation confirms efficacy of controlled clinical trials. J Am Coll Cardiol. 2017;70(4):451-452.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.140 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.005 | 0.004 |
| Scholarly communication | 0.004 | 0.008 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.016 | 0.030 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".