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Commentary: Unintended consequences of governance

BMJ 2011; 342 doi: (Published 26 May 2011) Cite this as: BMJ 2011;342:d2865
  1. Ben Bridgewater, consultant surgeon1, honorary reader2
  1. 1South Manchester University Hospitals NHS Trust, Manchester M23 9LT, UK
  2. 2Manchester Academic Health Science Centre, University of Manchester
  1. ben.bridgewater{at}

Treasure and colleagues present data on the Ross operation and argue that it has a place for treating younger patients with aortic valve disease and may be a better option than surgery with conventional valves. Despite good reported short and longer term outcomes after the Ross procedure, they suggest that low volumes in the UK are due to intense scrutiny of mortality, which is driving surgeons to offer a treatment with the lowest procedural risk (which is measured) rather than the best overall lifetime risk to the patient (which is not). The arguments presented are around the Ross procedure, but the themes are generic and highlight concerns about the importance of using the “right” measures and possible unintended …

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