In 2015 one of my patients in the Fourier PCSK9 inhibitor trial asked me if I would like to attend his ‘bespoke’ total knee replacement operation. I said yes and witnessed an amazing procedure.
A CT scan of his diseased knee was sent to Boston USA, where they created two 3D models, one of his diseased knee and another of a computer generated perfect knee. The former was used to plan the minimally invasive cutting of his actual knee to reduce blood loss and damage, the latter was used to mold his knee replacement. I know what I will want when my knees reach their sell-by-date. So, it was fascinating to read John Pepper’s account of their ‘bespoke’ Personalised External Aortic Root Support ExoVasc mesh, not least because the second author Tal Golesworthy invented it and was the first recipient.
Still on the patient involvement theme we have a report by Honey Thomas et al. on the North of England pilot of a shared decision-making aid for the implantable cardioverter-defibrillator (ICD). This is a fundamental requirement for NICE at this time. I have had patients where the insertion of an ICD turned out to be very unsuitable, resulting in them being turned off, a considerable waste of money as well as pointless discomfort for the patient.
These are among several excellent reads in this edition such as a ‘cracker’ from Ireland on coronary lithotripsy by Paula Finnegan.