Antonio Polanco, MD @APolancoMD profile

Antonio Polanco, MD

@APolancoMD

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265

Cardiac Surgeon @HopkinsCTSurg . Deeply interested in the Aorta and Heart Transplant.

Baltimore, MD

Joined April 2022

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Antonio Polanco, MD

@APolancoMD

2 years

I was asked yesterday if I had any networking advice for junior CT Surgery trainees. I shared these ideas and I hope they are helpful. #MedTwitter #CTSurgery #MedEd #MedStudentTwitter

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Antonio Polanco, MD

@APolancoMD

2 years

@macaron_md_ @Abiomed @drraycleemd @AhmetKilicMD @AkiItohMD @chris_lawrance_ Thank you! Starting Cvp was 20, pap 70s/30s. Coming off Cvp 8-10, pap down to 30/teens, lv function around 20%. Came off at P4 with epi 0.06. Extubated now. Doing well

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Antonio Polanco, MD

@APolancoMD

2 years

@benbryner I have never agreed with something so much. Thanks for sharing these thoughts.

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Antonio Polanco, MD

@APolancoMD

2 years

1. Get on social media. It makes it easier to see emerging procedures and journal articles. Many junior and senior faculty are joining social media and are happy to respond to a direct message with great advice.

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Antonio Polanco, MD

@APolancoMD

2 years

@LuisCastroMD @CristianRosuMD @MarcMoonMD @DrZeigler1 @M_Pompeu_Sa_MD Awesome Dr Castro. Thanks for providing this video. Were you always doing it this way? What do you think is least important, pledgets or distance between sutures. Fascinating.

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Antonio Polanco, MD

@APolancoMD

6 months

@jloumiotis @AortaSurg @M_Pompeu_Sa_MD @DrZeigler1 @VascularForum @DrWheatley Agree! Nice job with this. Central cannulation should be a part of your toolbox even if it’s not your preferred technique!

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Antonio Polanco, MD

@APolancoMD

2 years

@omar_dawoud @AhmetKilicMD @AkiItohMD @JoseNaviaMD @LuisCastroMD Hemi commando- aortic root replacement with aortic homograft and Mitral valve repair using the anterior leaflet of mitral valve that comes on the homograft. @JoseNaviaMD popularized it. I Learned it from @StephenSpindel and @AkiItohMD V

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Antonio Polanco, MD

@APolancoMD

2 years

@cvmangukia @BoYangMD @LaurenBarronMD @matt_schill @lindaschulteMD @erin_schumer I think this is a great question. I wonder what @BoYangMD thinks about this. Nevertheless, I had a retrograde catheter in and gave a dose of cardioplegia after sewing in the patch and had excellent flow out of the left main.

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Antonio Polanco, MD

@APolancoMD

2 years

@drraycleemd @jaye_weston @PeterDowneyMD @AortaSurg @DrZeigler1 @tomcnguyen @koriannj @DrDePasquale @EcmoNinja @StephenSpindel @LuisCastroMD @USCHeartFailure Seems like aberrant rsca. I know you love Samurai, but true lumen seems easily accessible Seldinger here. When would you consider deviation from samurai? Would you cut down ax and do bypass to RSCA or just do dissection repair? Thnx for sharing.

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Antonio Polanco, MD

@APolancoMD

1 year

@SurgeryBro You telling me there isn’t a Type A dissection going at 315am? How are you not in the OR?

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Antonio Polanco, MD

@APolancoMD

2 years

@ProleneQueen Thanks for sharing this. Im going through something similar right now. It is very easy to feel alone. Hope things get better for you.

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Antonio Polanco, MD

@APolancoMD

2 years

5. National meetings are great but choose to go to a local or regional meeting at some point in your training. The meetings are more intimate and may be higher yield.

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Antonio Polanco, MD

@APolancoMD

2 years

@PaulTangMD I do it the same way. It also makes a very easy transition to VA ecmo if you have PGD.

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Antonio Polanco, MD

@APolancoMD

2 years

6. Lastly, if you are interested in working at a specific place reach out early. Check in with the chief at the program every 6-12 months and update them on your progress. When the time comes for finding a job this will prove helpful.

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Antonio Polanco, MD

@APolancoMD

2 years

@curmudgeoncard I completely agree with you! Many bicuspid patients in the community are told about TAVR and referred to specific TAVR operators. Some will offer it and others will not. Luckily for this patient he was not.

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Antonio Polanco, MD

@APolancoMD

2 years

3. Ask any industry reps to invite other trainees from nearby training programs to dinner. Share your experiences, training, thoughts and approaches to finding jobs!

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Antonio Polanco, MD

@APolancoMD

2 years

@georgetolisjr I have thought about this same point a lot. What is your preferred method of ARE? Do you have Intraop photos you can share?

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Antonio Polanco, MD

@APolancoMD

1 year

@SurgeryBro Just messing with you man. All good stuff. I’m Sure in a few years you’ll be firing up those cases left and right. Stay strong!

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Antonio Polanco, MD

@APolancoMD

6 months

@jloumiotis @jisaezdeibarra @AortaSurg @M_Pompeu_Sa_MD @DrZeigler1 @VascularForum @DrWheatley Dissection surgery presents variable challenges. I agree with @jloumiotis that central cannulation is quick, can apply to almost everyone, and is especially useful for patients with large habitus. When you make it your standard it’s hard to go back.

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Antonio Polanco, MD

@APolancoMD

10 months

@ColumbiaCTSurg Sameer!!!

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Antonio Polanco, MD

@APolancoMD

1 year

@JoChikweMD @CedarsSinai Teaching transplant surgery is such a privilege. Your faculty and trainees are very fortunate to have such a wonderful experience. Great job!

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Antonio Polanco, MD

@APolancoMD

2 years

@LuisCastroMD @StephenSpindel @drraycleemd @AkiItohMD @AortaSurg @DevenPatelMD @OPreventzaMD @AspiringCTS Xenosys! They are a Korean company that I believe used to work with the Korean military. Loupes are extremely lightweight and the headlight is the best I have ever used! I tell all fellows and residents to give them a try.

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Antonio Polanco, MD

@APolancoMD

2 years

@mkayatta @ChrisMalaisrie @GChadHughesMD @DrZeigler1 @BoYangMD @drraycleemd Thanks for the question. I use epi aortic ultrasound and put the needle through false lumen get pulsatile bleeding, see it stop at the septum and see it reappear when I get in the true, advance wire and confirm on TEE. Backup plan is Samurai.

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Antonio Polanco, MD

@APolancoMD

2 years

@drraycleemd @georgetolisjr @EcmoNinja @SergeKobsaMD A pulmonologist told me not too long ago he was waiting for a RCT before he referred anyone for ECMO. Until then all patients need is a good intensivist. ECMO is alive and well in big academic places, but remains a mystery everywhere else.

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Antonio Polanco, MD

@APolancoMD

2 years

2.Ask your program director to take an active role in selecting grand rounds speakers. Not only will you learn the process but this will push you to figure out who are the key players in the field and will make socializing with them easier.

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Antonio Polanco, MD

@APolancoMD

2 years

@JJahanyarMDPhD @LuisCastroMD @AortaSurg @ShinFukuharaMD @drraycleemd @JoChikweMD I agree with you both upon tailoring strategies. However, I do think that trainees and junior Attendings need to develop a routine/framework for doing these cases in a reproducible way as they do not always come in when help is available.

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Antonio Polanco, MD

@APolancoMD

2 years

@CCF_CTSRes @NadiaBakirMD @TallRoundsTM @LarsSvenssonMD @AskDrMarc @karamlou @JamesJYunMDPhD @RohunBhagat @DurbakEmily @jbumana @Haley_Jenkins94 Great to see you doing big things @NadiaBakirMD !

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Antonio Polanco, MD

@APolancoMD

2 years

@jaye_weston @AortaSurg @ShinFukuharaMD @drraycleemd @LuisCastroMD @JoChikweMD @KeckMedUSC Alex thanks for the reply. Great to know within same institution people are doing different things. Samurai for every dissection? @drraycleemd do you have a video?

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Antonio Polanco, MD

@APolancoMD

2 years

4. Ask your PD or chair to reach out to other PDs and pool contacts of other local CT Surgery trainees. Have an email list, share ideas and meet up.

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Antonio Polanco, MD

@APolancoMD

2 years

@drraycleemd @LuisCastroMD @StephenSpindel @AkiItohMD @AortaSurg @DevenPatelMD @OPreventzaMD @AspiringCTS Mentally rehearsing daily. @SergeKobsaMD @JacobKriegel @StephNguyenMD @morgan_moroi

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Antonio Polanco, MD

@APolancoMD

1 year

@EcmoNinja @georgetolisjr Groin fellowship is a must before graduating. @drraycleemd @SergeKobsaMD

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Antonio Polanco, MD

@APolancoMD

6 months

@AkiItohMD @BrighamCardiac Great job Dr itoh!

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Antonio Polanco, MD

@APolancoMD

2 years

@drraycleemd @edisonskendo @EcmoNinja @PeterDowneyMD @john @jaye_weston @AkiItohMD @DTPham_CVSurg Looks like a great case. Seems like you did ax/innominate cannulation, and did acp for this. How cold do you go? Do you close the pda with a specific patch, maybe double patch? Great stuff man

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Antonio Polanco, MD

@APolancoMD

2 years

@FiedlerAmy @AortaSurg @ShinFukuharaMD @drraycleemd @LuisCastroMD @JoChikweMD Agreed!

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Antonio Polanco, MD

@APolancoMD

2 years

@LuisCastroMD @M_Pompeu_Sa_MD @AortaSurg @Abedeanda I agree with you. I attended a lecture by Steve Lansman in 2018 and his data revealed the incidence of arch dilation after hemiarch was quite low, and the morbidity of those redo operations were low. I’ll stick to hemiarch unless arch entry tear, or arch>5cm.

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Antonio Polanco, MD

@APolancoMD

2 years

@drraycleemd @TerumoAortic @koriannj @SergeKobsaMD @PeterDowneyMD @AortaSurg @EcmoNinja @KeckMedUSC @USCHeartFailure @DrDePasquale @drgnz0 @jaye_weston Nice job man

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Antonio Polanco, MD

@APolancoMD

2 years

@LuisCastroMD @CristianRosuMD @AortaSurg @ShinFukuharaMD @drraycleemd @JoChikweMD Agreed. I always control the LCCA and watch the cerebral sats and do not hesitate to go to Bilateral ACP or put tension on my vessel loop that controls the LCCA.

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Antonio Polanco, MD

@APolancoMD

2 years

@CristianRosuMD @AortaSurg @igeorge1975 @KyleEudaileyMD I went into the case hoping to do a Bioroot for the reasons you and Dr Dela Cruz mention, but it was clear it would likely not work.

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Antonio Polanco, MD

@APolancoMD

2 years

@KateEEngelhardt @WashU_CT Awesome photo guys. Miss you all!

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Antonio Polanco, MD

@APolancoMD

2 years

@AkiItohMD @BrighamThoracic Nice job!

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Antonio Polanco, MD

@APolancoMD

10 months

@WhitneyBrandtMD @BryanMeyers46 @AmitPawaleMD @WashU_CT Great job Whitney!

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Antonio Polanco, MD

@APolancoMD

2 years

@chris_lawrance_ @BoYangMD @SIUcardsfellows @SIUGenSurgRes @siusom You tried it!!!! Nice job.

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Antonio Polanco, MD

@APolancoMD

2 years

@LaurenBarronMD @JoChikweMD @SKeshavjee @OuzounianMD @MarcMoonMD Thanks for posting Lauren. Truly a great initiative. Many years ago @JoChikweMD mentored me, glad to see more people have this opportunity!

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Antonio Polanco, MD

@APolancoMD

2 years

@KyleEudaileyMD @igeorge1975 @AortaSurg Thanks Kyle. Yes it is! He Dehisced his root twice and after those 2 attempts failed he had attempted amplatz closure, which failed. I did him at 6 months after his last sternotomy. Annulus was destroyed so elected to use homograft.

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Antonio Polanco, MD

@APolancoMD

2 years

@drraycleemd @jaye_weston @AortaSurg @JasonHanMD @LuisCastroMD @EcmoNinja @DrZeigler1 @JJahanyarMDPhD @koriannj @USCHeartFailure Great job Ray! You are a great teacher.

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Antonio Polanco, MD

@APolancoMD

1 year

@AkiItohMD Well deserved. You were my best teacher as well. Congratulations!

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Antonio Polanco, MD

@APolancoMD

1 year

@jwgreenberg_md @KeckMedUSC @UscCardiac @Eric_Hyzny You guys are lucky. Lots of great people to train with @drraycleemd @SergeKobsaMD

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Antonio Polanco, MD

@APolancoMD

1 year

@WashU_CT Congrats. What a great group!

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Antonio Polanco, MD

@APolancoMD

2 years

@Abedeanda That’s awesome! Would you mind sharing any tricks you have? I’ve heard some surgeons make these patients inoperable which I don’t think is unreasonable. Kudos to you for taking these cases on.

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Antonio Polanco, MD

@APolancoMD

2 years

@cirujano_cardio @AortaSurg @igeorge1975 @KyleEudaileyMD I agree. My preference was to bioroot but tissue did not allow that option. I tried to cut the homograft as low as possible and leave a lot of graft to facilitate cross clamping and future AVR. I used size 29 homograft so can accommodate a big valve.

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Antonio Polanco, MD

@APolancoMD

2 years

@CristianRosuMD @AortaSurg @igeorge1975 @KyleEudaileyMD Thank you Dr Rosu. He presented to me persistently febrile with positive blood cultures at 3 months post his second operation, requiring iv abx. While I did not appreciated a clear abscess or pus, the annulus was destroyed making infection most likely.

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Antonio Polanco, MD

@APolancoMD

2 years

@omar_dawoud @AortaSurg @igeorge1975 @KyleEudaileyMD He Dehisced one month after surgery. He underwent repeat sternotomy to place a few sutures and this failed so then an attempt was made to plug the PSA percutaneously. Ultimately this failed as well and he was referred to me.

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Antonio Polanco, MD

@APolancoMD

1 year

@dkassjhu @stevenhsu_md @hopkinsheart Congrats @stevenhsu_md

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Antonio Polanco, MD

@APolancoMD

2 years

@DeBrabandereK @michael22joseph @ChrisMalaisrie @GChadHughesMD @DrZeigler1 @BoYangMD @drraycleemd Axillary is a great strategy and skill to have. I do think in this case a cutdown would have carried on longer than I would have liked. Experience with different cannulation strategies allows you to tailor the best option for the specific patient. Just my belief.

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Antonio Polanco, MD

@APolancoMD

2 years

@AortaSurg Dr de la Cruz, Is this a Yang root enlargement in setting of full root replacement? Very near.

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Antonio Polanco, MD

@APolancoMD

2 years

@GianTorre610 @Coronary4front @TSRA_official @mainlinehealth @FaisalBakaeen @pomyers @VictorDayan1 @rodrigo_md_79 Awesome man!

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Antonio Polanco, MD

@APolancoMD

2 years

@AkiItohMD Do you find it easier to use than the HM2 obturator with the tie band?

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Antonio Polanco, MD

@APolancoMD

6 months

@KateEEngelhardt @AATSHQ @whitney_brandt @erin_schumer @WashU_CT @ct_musc @UofL_cts Great group!!!

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Antonio Polanco, MD

@APolancoMD

2 years

@SurgeryBro Crush it bro

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Antonio Polanco, MD

@APolancoMD

2 years

@LuisCastroMD @M_Pompeu_Sa_MD @AortaSurg @Abedeanda Great job Dr Castro. How cold do you go? What is the body size of this patient? Have you ever had issues with right hand isechemia or hyper perfusion? Out of curiosity what is your indication for a zone 2 arch/total arch in dissection cases?

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Antonio Polanco, MD

@APolancoMD

1 year

@AkiItohMD What surgery is this? Avr, LVAD?

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Antonio Polanco, MD

@APolancoMD

2 years

@alex_ghannam @ct_musc Nice job sensei!

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Antonio Polanco, MD

@APolancoMD

2 years

@AkiItohMD @BrighamThoracic Patch leaflet? Neochord? Thoughts on annuloplaty with piece of bovine pericardium?

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Antonio Polanco, MD

@APolancoMD

1 year

@LuisCastroMD @M_Pompeu_Sa_MD @BaoGTran @StanfordCTSurg @AspiringCTS Very impressive. Do you fully reverse heparin? How early do you start dapt? How do you stabilize the intima? Vein patch or no? This is a very high risk and I agree it’s a very special skill. Congrats to you and the patient.

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Antonio Polanco, MD

@APolancoMD

8 months

@SuguruOhira I find many of these PGD patients on ecmo are coagulopathic and require transfusion. Central ecmo for 24 hrs and then conversion to peripheral takes oxygenation and thoughts of limb ischemia out of the equation in the first 24hrs. Just my thoughts.

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Antonio Polanco, MD

@APolancoMD

2 years

@bapat_savrtavr Great app Dr Bapat! Hope all is well.

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Antonio Polanco, MD

@APolancoMD

1 year

@HopkinsCTSurg @HH__Wang @hopkinssurgery @HopkinsMedicine @HopkinsACCM @hopkinsheart @HopkinsMedNews Great work @HH__Wang !

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Antonio Polanco, MD

@APolancoMD

2 years

@KateEEngelhardt @ct_musc Bernice and Kate! U guys r so lucky!

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Antonio Polanco, MD

@APolancoMD

3 years

@KyleEudaileyMD @AkiItohMD @drraycleemd @KunalKotkarMD @GianTorre610 @bypasstheordnry @LaurenBarronMD Kyle, 100% agree. I’ve decided for BIMA patients must be age<60, a1c<7, BMI<35 and be a non-smoker. I’ll let you know how it goes. How do you decide?

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Antonio Polanco, MD

@APolancoMD

2 years

@drraycleemd @USCHeartFailure @EcmoNinja @AkiItohMD @SergeKobsaMD @DTPham_CVSurg @koriannj @DrDePasquale @Abiomed @ajay_vaidya @wolfsonaaron @jaye_weston Great stuff Ray. The entire team is doing great work.

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Antonio Polanco, MD

@APolancoMD

2 years

@Ali_KhiabaniMD @matt_schill @ellen_schill @LaurenBarronMD @lindaschulteMD @KateEEngelhardt @WhitneyBrandtMD @PujaKachroo @KunalKotkarMD @MFarazMasood @matt_schill congrats man!!!

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Antonio Polanco, MD

@APolancoMD

2 years

@drraycleemd @PeterDowneyMD @AkiItohMD @EcmoNinja @koriannj @DrDePasquale @tomcnguyen @USCHeartFailure @KeckMedUSC Nice work man. I have to come out and watch you do a few!

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Antonio Polanco, MD

@APolancoMD

2 years

@WomenInThoracic @NadiaBakirMD @ScanlanInc @UmAvielB @AlexisChidi @maraantonoff @Daniela_Molena @SKHillMD Sensei @NadiaBakirMD . Nice job.

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Antonio Polanco, MD

@APolancoMD

2 years

@RootGal210 @Abiomed @drraycleemd @AhmetKilicMD @AkiItohMD @chris_lawrance_ Thanks for the question Dr Still. No coronary disease. Had severe AS for 3 years without referral for treatment, with incremental decline in EF. 2 HF admissions in past 3 months which led to referral to TAVR clinic. LVEDD around 6, so not terrible.

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Antonio Polanco, MD

@APolancoMD

2 years

@KateEEngelhardt Great stuff Kate!

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Antonio Polanco, MD

@APolancoMD

2 years

@NataliaRoa_ @STS_CTsurgery Great job!

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Antonio Polanco, MD

@APolancoMD

10 months

@SaadHasanMD @BoYangMD @TCHheart Great job @SaadHasanMD !

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