Abdel Almanfi, MD, FACC, FSCAI
@Almanfi_Cardio
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TAVR Proctor | Structural Heart Interventional cardiologist | EndoVascular/Coronary Interventions| Baylor St. Luke’s | trained @Texas_Heart | ⚽️ ♟️ | 🇱🇾 🇺🇸
Houston, TX
Joined February 2011
Proud to be part of this . First-in-human report of percutenous repair TEVAR of Ascending Thoracic Aortic Aneurysm “ATAA” using minimalist approach with conscious sedation/local anesthesia in 79-year-old M who couldn’t undergo surgical repair d/t to high risk co-morbidities.
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We only see small part of the coronary circulation when we do heart catheterization!.
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Successful people:.1 Wake up early. 2 Talk less. 3 Stay laser focused. 4 Don't waste time. 5 Live healthy. 6 Ignore nonsense.
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A friend sent me this quote & I thought it deserves a tweet . “The one who works with his hand is a craftsman. The one who works with his mind is a scientist. The one who works with his heart is an artist. But the one who works with his hands, mind, and heart is a doctor.”.
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Great news, our brave cardiology fellow Patel from NY is out of the hospital after trying multiple medications, I am very glad he is back to his family . #🚫COVID-19.
11th day today, finally no fever for 2 days in a row. Still can't talk due to coughing bouts, but O2 level good on room air. Being discharged now. Thank you everyone for incredible support 🙏🏽and Lots of love ❤️❤️. Still won't be able to 🤗 and 😘 wife and little girl for few days
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I am so happy to announce that I accepted a new position at @mercy_health in Paducah Kentucky where I will be serving as Medical Director for Structural Heart Program . I am very excited to come back to Kentucky and write new chapter in my life and my career.
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The best way to fight heart attacks is to be on the front line . received my 55 years female STEMI patient at the helipad, wheeled her to cath lab, time to stent was 19 minutes. Love ❤️ what we do even if means sleepless weekend . one live saved at a time.
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Last week was arguably ☝️ of the best weeks in my life. After proctoring #TAVR cases in Houston, submitted 2 papers for publication, presented 3 talks at @CRT_meeting 2022, accepted a new structural position & most importantly, I became a US citizen after 14 years in USA 🇺🇸
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Rare but Important condition to recognize in TAVR world;.-----.Management of Suicidal LV after #TAVR is similar to that of HOCM: .⬆️preload with IVF .⬆️afterload – phenylephrine is the pressor of choice .🚫inotropes and consider treating with neg inotropes such as BB/CCB
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كما وعدنا أوفينا لأن وعد الحر دَين عليه . من قلب بنغازي و إستعداد ليوم آخر من العمل والعطاء لأهلنا وناسنا وبالتعاون مع الزملاء في مركز القلب بنغازي ، تستمر ورشة العمل التطوعية للكشف على المرضى و التشخيص و القيام بعمليات القسطرة للشرايين الطرفية و شرايين القلب! .—————.عبدالقادر
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Prior to October 2020, my hospital had zero structural case history. Since then, we did 25 #TAVRs,including Perc. Axillary TAVR, valve in valve with fractures,#TMVR ViV, started #MitraClip,PFO closure & Watchman programs. 1st radial to peripheral & 1st TEVAR.Big transformation 💪
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This is literally a surgical embolectomy without opening the chest, saddle Pulmonary Embolism treated with @InariMedical, urgent embolectomy, No lytics, immediate hemodynamic improvement, with hospital discharge in 24 hours. Pulmonary Embolism is the 3rd leading cause of death
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There’s nothing more rewarding than saving a life . Left main STEMI causing cardiac arrest, 7 DC shocks & Cardiogenic shock was saved by great teamwork, skillful & dedicated co-workers. Good CPR & promptly placing Impella CP & primary PCI,Impella explanted/extubated same day 💪.
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This is the future for non-surgical, Transcatheter approach for patient who need Aortic valve replacement & ascending aneurysm exclusion . TEVAR + TAVR and coronary chiemny stents. In other words, Endo-Bentall.
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I am very thrilled to announce that I have finally accepted a new position as structural heart interventional cardiologist in my favorite city (Houston, Texas). So glad to be back to H-Town, back to Texas 🙌 after 6 years since fellowship!
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One ☝️ of the most challenging PCIs with Syntax Score 73, Severe CAD >80% distal LM, all 3 major epicardials were 100%, CTO mid LAD, Ostial LCX flush occlusion, RCA non dominant CTO,EF 35%,daily angina/SOB Pt refused CABG,Fully revasc. his left system with #Impella,home in 24 hrs
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Left main STEMI with cardiogenic shock is the worst nightmare for any interventional cardiologist . the key is keep your cool, do your best effort, that means one precious life saved 🙌!
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10 years ago, I arrived to USA, I knew no one here, had nothing but my medical degree & big dream . Thanks to almighty God, my supportive wife & the great mentors . #NeverGiveUp .#TheAmericandream
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Great case I performed with my team (the 1st in West Kentucky region)TMVR ViV using 29 mm S3 valve to Rx pt with severe bioprosthetic Manga (27 mm)failure, used VersaCross & steerable @BaylisMedical sheath for transeptal. fantastic results, final MG 2, 🏡 next day.@EdwardsLifesci
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I have strong feeling that after this Corona crisis is over, US health system will witness many +ve changes, one of them is physician leadership. Physicians & of course nurses knows what’s best for patients & will always strive to do the best, stop treating hospitals as corporate.
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So proud to report successfully performing the first-ever Left Percutaneous Axillary TAVR in the state of Texas (no surgical cutdown). My pt received 29 mm Evolut FX valve, discharged home in 24 hours. Great team-work leading the way to help sicker patients with limited options.
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This is super amazing #TAVR valve, challenging case of severe AS with heavy calcified bicuspid valve, Lotus edge was the right choice, stable deployment, stable hemodynamics, no rapid pacing. Final result superb. No PVL, mean gradient 8 mmHg, no rhythm issues. Wow . 🏡 in 24 hrs
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My best #TAVR save for 2018.Cardiogenic shock & cardiac arrest post deployment, total LM occlusion,CPR 25 min,DC shocks x3, placed pt on perc. fem-fem pump using TAVR access, finally got LM opened/stented,pt left hospital 3 days later,normal LV, Aortic valve & brain functions🙌💪
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This proud structural cardiologist is fixing 4-5 valves weekly. What an awesome job, I can’t ask for anything better 🙌
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Our 1st Impella RP & it was big save . 65 yr old pt, bilateral pulmonary embolism, cardiogenic shock on multiple pressors, mechanical vent. Severe RV failure despite EKOS, after 3 days, Impella explanted, extubated, Off pressors, back to her family #heartrecovery #PE #Impella
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For #TAVR implanters & structural fellows learning CoreValve Evolut R deployment, deciding what depth you place your valve is very crucial . This thread will be dedicated to “the best practices” that can help guide you in procedural steps!
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Maturity in Interventional Cardiology isn’t about doing more cases, although numbers count, It’s rather about growing into “decision making” process . It’s about good planning & knowing why, when & how to do things!!. AA.
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Great honor to perform our 1st (TPVR)Trans-catheter Pulmonary Valve Replacement, complex case S/P Ross pro. 25 yrs ago, degenerated surgical graft. Rx”d with valvulplasty, placement of CP covered stent & 23 S Sapien.Great teamwork + careful planning = successful outcome 👌! . AA
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This is an infection control teaching during epidemics 1400 years ago . .
Prophet Muhammad advised quarantining to contain a deadly outbreak. He said:. “If you hear of an outbreak of plague in a land, do not enter it; if the plague breaks out in a place while you are in it, do not leave that place.”. A timely hadith in light of COVID-19. Stay safe.
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Very challenging #TAVR .Highly tortuous thoraco-abdominal aorta, large annulus with very horizontal aorta - angle 📐 @ 90 degree. Deployed 29 S3 with 2 cc extra. Trace PVL & 5 mmHg gradient.
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Coronary access after self-expandable Evolut #TAVR . If commissural alignment during valve deployment was done appropriately, left main & RCA acces will be quite easy for future PCI, the open cell is large enough to accommodate 2 or 3 guide catheters easily.@MDT_StructHeart . AA
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This is how #TAVR is becoming so simplified & streamlined, deployed 29 mm Evolut CoreValve, MAC sedation, no TEE, no recapture, no PVL or PPM. Mean gradient 3 mmHg,AVA 2.6.Whole case skin to skin took 35 minutes, went to regular cardiology floor. Discharged home next day. 😊
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After we expanded our #TAVR program in May, we launched #Mitraclip program in June & now we are proud to announce the start of our #Watchman #LAAC program with 1st case . thanks to all team members! .Success breeds more success.
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Like this quote . I interviewed 3 Interventional cardiology candidates for a position at my institution over the last week, I ranked them based on personality, attitude & being more of a team player. Skillset is important but can be attained with time & exposure.
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Had a very productive day yesterday starting with .2 #TAVRs, one 26 Evolut R Pro & 26 S3. #RadialFirst Inferior STEMI Primary PCI & EKOS catheter for massive PE Tx with 4 hrs infusion of 8 mg t-PA . This is the kind of practice I envisioned myself doing as interventionalist!
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Very happy to announce that I will be collaborating with Medtronic #TAVR team as a consultant & proctor . Very exciting times in my career to start helping new centers & operators develop programs, learn more about TAVR & other Structural Heart interventions . .
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It’s amazing how much we achieve with #MitraClip in 91-year-old pt who lives independently, admitted couple of times with congestive heart failure because of severe Mitral regurgitation . treated with one clip, discharged home in 24 hrs, Asymptomatic in 2 months follow up!
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For Structural fellows & interventionalist learning #MitraClip. This short video (45 sec) summarizes all steps, treated high risk surgical MR pt using 3rd generation XTR to reduce MR from severe to trace. Let’s discuss any questions about steps, equipments & case selection. AA
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Very excited to announce that I’ll be joining @ThedaCare Regional Medical Center, Appleton,Wisconsin as the Structural Program Director. Looking forward to expand the program & take it to the next level. Big thanks to all colleagues at @MyFranciscan, leaving wasn’t easy decision!
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أتمنى من الله العزيز القدير أن تكون سنة 2022 سنة خير وسعادة وصحة للجميع . Wish you all a happy & prosperous 2022 .——.AA
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What a phenomenal week . Performed 2 surgical turn-down Impella CP high risk PCIs.Two TAVRs one of them valve in valve with bioprosthestic valve fracture.Two PFO closures & .2 MitraClip 4G. Great teamwork, Thanks to @MDT_StructHeart @abiomedimpella @AbbottNews @BaylisMedical
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In my book, everything can wait, unless it is STEMI or cardiac Tamponade, everything else can wait, don’t let anyone rush you to the next case or next office visit etc. Always take your time & do the right thing!.
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Proud of my team, yesterday we expanded our #TAVR program by launching Lotus Edge valve in addition to recent addition of Sentinel Stroke protection. We achieved excellent outcomes in tough anatomy & challenging cases. Thanks to #BostonScientific team for the great help. ---.AA
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Glad to perform the first TEVAR ever done by interventional cardiologist in Indianapolis area. My pt has symptomatic type B thoracic Aortic Dissection with organ mal-perfusion, totally Percutenous repair, IVUS guided using two overlapping Medtronic Valiant Captivia endo-grafts!
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Successful 3 TAVRs in the same day using Medtronic Evolut FX valve . بتوفيق الله قمت بثلاث عمليات زرع الصمام الأورطي في نفس اليوم.
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So glad to put my hands on this niche product, Wattson Wire for #TAVR .First dedicated temporary pacer wire in the LV cavity that might make TAVR simpler and probably safer. No need for venous access or RV pacing catheter. @TeleflexCardiol
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The big question now is; Who should get SAVR?.IMHO, #TAVR will be the standard of care as long as anatomy is feasible,SAVR will be limited to:.- Very young pt who accept mechanical valve .- Pt who needs double/triple valves or CABG.- Bicuspid AV + Ascending Aortic Aneurysm repair.
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One ☝️ of the best saves.Young pt w acute stroke, B/L DVTs, massive PE, large PFO, cardiogenic shock intubated on mech. Vent, on pressers. Did imultaneous PFO closure, clot suction from R & L PA, right atrium using Inari, times 3 CPR intra-op.Survived to discharge 🙌@InariMedical
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Great honor to be selected to serve a 3 years term on the SCAI’s Structural Heart Disease Council. Looking forward to serve & working closely with the Council Chair & all the members. @SCAI_Prez @SCAI @Herms2James
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Crazy weekend with 6 STEMIs. 49 yr old came to ER c/o chest pain, cardiac arrest just after EKG,CPR 30 mins,incessant Vtach, DC shock x 7 in ER & cath lab. Impella CP placed, LAD opened & stented, prox LXC stented. I can’t thank my team enough, although they think I’m black cloud
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This is my technique to engage left main in #TAVR patient with Evolut Pro+ CoreValve. Undersize your catheter by 0.5, use J wire .This was done via right ulnar approach due to small size radial artery. #StructuralHeart .@MDT_StructHeart
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Age should never be sole determining factor for delivering appropriate therapy, this is active & functional 96-year-old Male living with his wife at home, presented with symptomatic severe mitral regurgitation, did one #Mitraclip XTR clip on him, discharged home in 24 hours.
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Proud of my structural heart team @ThedaCareHealth after we performed the 1st #Mitraclip in the region . last month, our #TAVR program expanded to include CoreValve Evolut beside Sapien S3 valves . We continue to build center of excellence .
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Wow . reading these new guidelines makes me very proud . this is exactly what my #TAVR tweets have been about over the last year . - Patient with severe AS over age 80 TAVR .- 65-80 shared decision with TF TAVR first option .- Less than 65 surgery as first option. #TAVRfirst
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Had a great week between clinic, hospital and cath lab, also officially kicked off our structural heart/valve program . great thanks to all those involved, teamwork is always THE key! .—.AA
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Emergent #TAVR yesterday on 71 yr old, Very sick pt with cardiogenic shock, on multiple pressors, renal failure on CVVH STS score 18%, we used 26 mm Evolut Pro . left the hybrid OR with BP 160/90, off pressors . Thanks #Medtronic for being available at 6 am to help our sick pt.
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My philosophy is you need to get the best training/education possible at a prestigious place, after that, you should branch out, go where are you are mostly needed & be a big fish in small pond. Don’t stay & compete with your mentors . Build your name and your own legacy!.
Should You Always Strive to Work at the Most ‘Prestigious’ Places? Well … - The New York Times
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Happy & successful 2025 my friends from my little office in Houston TX.
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Ending 2019 with strong note, last #TAVR day of the year, did 3 TAVRs with 3 different valves, 29 Sapiens S3, 26 Evolut Pro + and lastly 27 #LotusEdge.All minimalist, all received #Sentinel stroke protection devices.All received #Manta closure devices. All were home next day 👌
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Lovely 3D TEE image at the end of #Mitraclip procedure for severe degenerative MR!.The key element for any successful structural program is strong supportive imaging (interventional Echocardiographer) .
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Very interesting!.Rota stuck on under-deployed Stent in heavily calcified lesion from previous PCI attempt, I used guide deep engagement with traction tech. to get the Burr & stent out . I never knew that I can use Rota Burr as “snare”😜. Atherectomy & PCI went well afterward!
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Got my COVID-19 vaccine today . I hope we can put an end to this pandemic by 2021.———.الحمد لله اليوم خذيت جرعة لقاح الكورونا . أتمنى ان تكون سنة 2021 سنة نهاية الوباء ، أتمنى للجميع السلامة.
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For accurate Sapien3 #TAVR deployment, it has to be slow deployment (total should take 6-8 sec). Then 2-3 sec more push to guarantee full expansion & no waist. I like Pigtail in the non coronary cusp for accurate depth assessment, leave it there till the end & remove over J wire.
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Give Impella to well trained hands & skillful physician who knows what the hell is he doing, it will be live-saving . putting the same device in clumsy hands, no skills, no training, the device will be a killer . Training/experience/education matters . So simple . .
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Would you believe it if I told you this 12 Fr delivery sheath is passing through all 4 chambers of the heart!?.Structural heart interventions has opened the gate for new technologies/techniques for patients who are not candidates for surgery! . My case description coming soon!
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Interesting case of uncrossable highly calcified lesion. Attempted twice at other hospital & was referred for bypass,I was able to cross with wire but no microcatheters could pass, added buddy wire with Iron man, guideliner,1 mm Sapphire balloon 🎈followed by Wolverines 🎈& stent
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The best TAVR is #TAVR done emergently on weekend to treat a pt in persistent cardiogenic shock & severe AS. For the 1st time, this pt has become off oxygen, off pressers in 10 days, discharged from hospital after being intubated! 🤞.——.Below is paper by Ferker et al about this
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I still see a valuable role for BAV in this era, this pt had severe AS, advanced COPD & frailty! Admitted with severe failure & shock, intubated, on IV pressors, our team decided for BAV. I used new TrueFlow balloon 🎈from Bard, extubated & sent home after 2 days, #TAVR in month.
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I officially informed my current employer & patients that I will be leaving, I am currently in the market looking for new opportunity in the next few months, if any of my friends/colleagues know about busy structural/endovascular opportunity, please don’t hesitate to reach out.
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Glad to know that my patient who I performed #TAVR on in 2019 with #Manta closure device is celebrating her 100th birthday 🎂 & doing well . This is amazing 😊.
One month follow up visit after #TAVR in this soon to be 99-year-old lady. Completely asymptomatic after admission with CHF prior to valve replacement , heading to Disney land with her family. Posted with patient’s & family permission.
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For me, this is a game changer for left side structural Interventions. VersaCross transeptal kit. For simplified septal crossing without single exchange, all in one step . No need for needle anymore. Thanks to @BaylisMedical for giving me access to this great technology. 🙌
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I was given the option for COVID-19 vaccine by our hospital (It's not mandatory), opted in and will receive 2 doses at predetermined interval. the 2nd dose (booster) is as important as the initial dose. I hope 2021 will bring an end for this nightmare.
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Glad to share our latest publication at @JACCJournals case report. Possible Novel approach.ICE guided utilization of FlowTriever (@InariMedical), 24-F Triever24 & 20-F Triever20 Curve aspiration catheters to treat Tricuspid Endocarditis.From @jaccjournals
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Received this heartwarming letter in the hospital mail from a patient in Wisconsin who I performed #MitraClip 18 months ago then I moved to kentucky for new practice. When you do good things, people will never forget you!.Love my job as interventional structuralist ❤️.———.-AA
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When you think your life is going bad, think again! .
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Symptomatic left Subclavian total occlusion, planned recanalization based on CT Angio. After cossing and PTA, Stented with 9 mm LifeStream covered stents. Remarkable relieve of symptoms on follow up.
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Very successful week for our structural heart program @ThedaCareHealth , 3 CoreValve #TAVRs with 3 #Manta closure devices, two #Watchman & Two #MitraClip cases. Proud of my team & staff, our program is growing very fast & becoming very comprehensive with more options. ——.AA
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2019 was difficult year, a lot of challenges & new lessons learned, in pursuing success we make sacrifices, despite burnout & enormous stress, we strive to put smiles on patient’s faces & their families, we shouldn’t also forget ourselves & smile as a team.Happy & prosperous 2020
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Life is way too short to take any drama in your life,whether it’s work or home. You are unique,so live your life,enjoy your life, celebrate your life,enjoy people in your life who encourage you to be better, live in the moment & don't waste time on people who add no value to you.
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I wanna share this Tweetorial with interventionalist & IC fellows regarding complex SVG intervention . with few tips & tricks esp. regarding use of EPD/filters. 80 yr old post CABG, with previous PCIs, presented with non STEMI, my non IC partner did the cath & called for opinion
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Post surgical aortic valve (21 mm intuity Edwards) SAVR, moderate to severe para-valvular leak (PVL) closed percutenously using 8 mm VSD occluder with complete resolution of the PVL, saves the patient from second surgery or ViV #TAVR
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Successful coil embolization of rare case of multiple coronary arteries to pulmonary fistulas in symptomatic patient using right #RadialFirst approach & deployment of 3 detachable interlock coils. Careful planning & risk assessment is important in such cases.
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I strongly believe that there is no better valve on the market better than larger self Expanding #TAVR valves for hemodynamics & durability,here is 34mm Evolut FX, precise deployment, no pre or post dil.F/U Echo -> no PVL dimensionless index DI 0.68 AVA 2.45 mean gradient 3 mmHg
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Sad story, saw this pleasant 80 yrs old as hospital consult for TAVR (severe AS/CHF) 2 months ago,offered him #TAVR he declined b/c of fear of COVID, came to our ER this weekend feeling bad,accepting Rx now, died next day on cardiac floor before work up. Don’t postpone procedures
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Celebrating new milestone for the structural heart program at HCA Houston Clear Lake Heart Hospital. Did the first case of second generation SavvyWire in Texas. Excellent outcome with 3 in 1 functions: pacing over the wire was consistent, deliverability was easy with similar
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Repairing leaky mitral valve using 4th generation XTW #MitraClip .Phenomenal results with mean gradient of 4 mmHg, ~ 24 hours hospital stay. The key is to be patient while placing/repositioning your clip & leaving behind NO leak 🙌. #StructuralHeart
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FDA updates;.———-.Medtronic Evolut™ #TAVR system receives new labeling for Low Risk Patients with Bicuspid Aortic Stenosis in the US .
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