Victor Garcia

Victor's statements about Lectures, Courses and Honors 14 statements

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Update Course Rewind: Pectus Excavatum 2021

Quotation I agree with Sean. It works. I mean, it is great, one day. Open

Statement There are no long-term studies on cryoanalgesia outcomes. Open

Quotation What I'm concerned about is, is that there are no long-term studies. Open

Quotation We don't have the long-term data. Open

Quotation Unlike drugs, medical devices and implants are not, are not required to undergo clinical trials before they're introduced into the market. Open

Statement Medical devices and implants are not required to undergo clinical trials before being introduced to market, unlike drugs. Open

Statement Erector spinal catheters are placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space. Open

Quotation Those catheters stay in for 5 days. The hospital stay is 2 days. 3rd day, while they're outside, the catheters are pulled out by the family. Open

Statement With erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days, and are pulled out by the family on day 3 while the patient is at home. Open

Statement Erector spinal catheters reduced opioid requirements both in the hospital and outside the hospital. Open

Quotation We've been able to reduce the opioid requirements, uh, not only in the hospital, but also outside of the hospital. Open

Statement With erector spinal catheters, hospital stays are 2 days, which is much less than the 4-5 days seen with epidurals. Open

Statement Using a sternal elevator in every case eliminates guesswork and allows entry and exit at the same interspace. Open

Quotation Steve, we use the um elevator in every case, uh, but it offers, uh, there's no guesswork. Open

Victor's statements about Pectus Carinatum 5 statements

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Pectus - Preoperative Assessment - Radiology and Cardiac Evaluation

Quotation arguably what is the most painful operation that could be done in a child Open

Statement The Cincinnati Children's approach is selective in identifying patients who will benefit from surgery and emphasizes helping patients and parents deal with pain and discomfort, minimizing workup risks (ionizing radiation), and mitigating chronic pain and substance abuse risk. Open

Statement Pectus excavatum repair is arguably the most painful operation that could be done in a child. Open

Statement Insurance companies require some metric (abnormal pectus index plus evidence of cardiac dysfunction or abnormality) to approve coverage; providing multiple indices (Haller, correction, depression) plus cardiac dysfunction evidence has been effective in reversing denials. Open

Statement When operating on younger patients, bars need to be shorter (not extending to mid-axillary line) to avoid impeding chest wall growth. Open

Victor's statements about Pectus Excavatum 91 statements

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Pectus - Preoperative Assessment - Radiology and Cardiac Evaluation

Statement Pectus excavatum repair is arguably the most painful operation that could be done in a child. Open

Quotation arguably what is the most painful operation that could be done in a child Open

Statement The Cincinnati Children's approach is selective in identifying patients who will benefit from surgery and emphasizes helping patients and parents deal with pain and discomfort, minimizing workup risks (ionizing radiation), and mitigating chronic pain and substance abuse risk. Open

Statement Pectus excavatum repair is arguably the most painful operation that could be done in a child. Open

Quotation arguably what is the most painful operation that could be done in a child Open

Statement The Cincinnati Children's approach is selective in identifying patients who will benefit from surgery and emphasizes helping patients and parents deal with pain and discomfort, minimizing workup risks (ionizing radiation), and mitigating chronic pain and substance abuse risk. Open

Statement Insurance companies require some metric (abnormal pectus index plus evidence of cardiac dysfunction or abnormality) to approve coverage; providing multiple indices (Haller, correction, depression) plus cardiac dysfunction evidence has been effective in reversing denials. Open

Statement Dr. Park in Korea, who performs the largest number of pectus repairs worldwide, argues that age 3 and older is safe for repair, and earlier is better. Open

Statement When operating on younger patients, bars need to be shorter (not extending to mid-axillary line) to avoid impeding chest wall growth. Open

Statement Overcorrection from excavatum to carinatum can occur if repair is done too early, particularly in patients with connective tissue disorders (reported by Hopkins group). Open

Statement Dr. Park reports seeing fewer asymmetric pectus patients because he corrects them when they're younger, suggesting early correction may prevent asymmetry development. Open

Update Course Rewind 2021 - Updates in Pectus

Quotation I come to this perspective from really an article by Jerome Grootman in the New Yorker, that then led me to a book, which I would argue everybody who's doing innovation in this space ought to read. And that is a expose as far as the abject failure, as far as how really the FDA and the government are monitoring the introduction of medical devices Open

Statement Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs. Open

Quotation I remember when Ravage was introduced, and then we were doing it in you know, adolescence, and then we went into smaller children. And then we find ourselves in with acquired thoracic, you know, dystrophy, and asphyxia Open

Quotation there are also cases in social media who are talking about the fact that they're on gabapentin. And when is this terrible nerve pain going to disappear? Open

Statement Cryotherapy devices received FDA approval via 510(k) predicate pathway based on similarity to devices from 1976, not based on clinical trials. Open

Quotation I challenge anybody on this panel to tell me that they're not long term consequences. And what are we going to do about that? Open

Statement With erector spinae catheters, hospital stay is two days with reduced opioid requirements both in-hospital and post-discharge. Open

APSA - Is same day discharge possible following the Nuss repair for pectus excavatum - R. Luke Rettig

Quotation I wanna begin with the question, uh, just because it can be done, uh, should it be done? Open

Quotation I personally don't feel that cryoablation is ready for prime time. Open

Quotation We really don't know what the long-term consequences of this. Open

Statement Medical devices typically are not subjected to the same rigorous, robust trials that drugs are Open

Statement Many adverse consequences for medical devices are either underreported or not reported, as suggested by Kaiser Health News Open

Statement The long-term consequences of cryoablation are unknown, particularly for children Open

Statement There is concern about chronic neuropathic pain as a potential consequence of cryoablation Open

Quotation I'm arguing for a trial, randomized controlled trial, as well as a registry so that we can track right Doctor Red results. Open

Update Course Rewind: Pectus Excavatum 2021

Statement Dr. Garcia's concern about cryoanalgesia is the absence of long-term studies and unknown potential for future adverse effects such as chronic neuropathic pain. Open

Quotation I agree with Sean. It works. I mean, it is great, one day. Yeah, no. So, um, what I'm concerned about is, is that there are no long-term studies. Open

Statement Dr. Garcia's concern about cryoanalgesia is the absence of long-term studies and unknown potential for future adverse effects such as chronic neuropathic pain. Open

Quotation I agree with Sean. It works. I mean, it is great, one day. Yeah, no. So, um, what I'm concerned about is, is that there are no long-term studies. Open

Quotation But I believe we just don't know. We don't have the long-term data. Open

Quotation You know, unlike drugs, medical devices and implants are not, are not required to undergo clinical trials before they're introduced into the market. Open

Statement Unlike drugs, medical devices and implants are not required to undergo clinical trials before being introduced to the market by the FDA. Open

Quotation You know, unlike drugs, medical devices and implants are not, are not required to undergo clinical trials before they're introduced into the market. Open

Statement Dr. Garcia's institution studied approximately 100 patients comparing epidurals to erector spinal catheters for pectus excavatum pain management. Open

Statement Erector spinal catheters are placed by the pain team with ultrasound guidance and are positioned juxtaposed to but not in the vertebral space. Open

Quotation Those catheters stay in for 5 days. The hospital stay is 2 days. 3rd day, while they're outside, the catheters are pulled out by the family. Open

Statement With erector spinal catheters, the catheters stay in for 5 days, hospital stay is 2 days, and on the 3rd day while patients are at home, the catheters are pulled out by the family. Open

Quotation Those catheters stay in for 5 days. The hospital stay is 2 days. 3rd day, while they're outside, the catheters are pulled out by the family. Open

Statement Dr. Garcia's institution achieved 2-day hospital stays with erector spinal catheters and reduced opioid requirements both in-hospital and at home. Open

Statement Erector spinal catheters achieve shorter stays than the 4-5 days seen with epidurals, though not the one-day stays achieved with cryoanalgesia. Open

Statement Dr. Wolon uses a sternal elevator for pectus excavatum repair at Akron Children's Hospital. Open

Quotation Steve, we use the um elevator in every case, uh, but it offers, uh, there's no guesswork. Open

Statement Dr. Garcia uses the sternal elevator in every case because it eliminates guesswork and allows entry and exit at the same interspace. Open