Nimesh Desai MD PhD
@NimeshDesaiMD
Followers
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Following
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71
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Cardio-Aortic Surgeon and Clinical Researcher 🇨🇦🇺🇸 #aorta #TAVR All tweets are my own. RT≠endorsement
Philadelphia, PA
Joined January 2019
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Massive Pulmonary Embolism with hemodynamic instability 24hrs post partum. Near total occlusion of both PA’s and MASSIVE clot burden.
Emergent open embolectomy. Patient walked out of the hospital!
Key: MUST retroflush pulm veins/ squeeze out lungs to expell ALL the clot
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#EndOfAnERA
Today, I bid farewell to my mentor, colleague, and friend for the past 15 incredible years,
@BavariaMD
as he moves onward to new adventures. Joe - your unparalleled wisdom has been the cornerstone of my career, and your friendship, a priceless gift. The global impact
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LAAOS III presented by
@RichardWhitloc2
at
#ACC21
LBCT - Surgical Left Atrial Appendage occlusion at time of heart surgery significantly decreased stroke in 4811 patients with preop AF. Practice changing for cardiac surgery.
@DrMoritzWvB
@BavariaMd
@Dr_Santangeli
@narrowQRS
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Important: Referral to an aortic surgeon is NOT just a referral for surgery. It is a referral to a multidisciplinary team for optimization, risk analysis/genetic testing, & lifelong care coordination. We operate on only a small percentage. Size is only one factor. Nuances.
Lots of eye-opening stuff in this paper. Are people referring aortas for repair now if the root is >5.0cm?
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Here is a short video of using Rummel tourniquets for hemostasis after
#TAVR
sheath removal... Simple, inexpensive, elegant and very effective.
Thx to
@VascularMD
for showing this to us and
@DrAliAzizzadeh
for first describing it!
@jaygirimd
@TaiKobayashiMD
@rimhalabymd
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Great work in JACC today on CABG vs PCI for multivessel CAD in diabetics. Take away: CABG is superior strategy with a LARGE survival advantage. Admin data but solid analytic approach. Is CABG being underused in diabetics?
@djc795
@mirvatalasnag
@GilbertTangMD
@DavidLBrownMD
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New GOLD standard in AVR presented at
#STS2021
by
@BavariaMd
5Y FDA IDE COMMENCE Trial. New Gen pericardial SAVR. Novel anti-Ca2+ Rx. 471pts, mean age 67, 5yr corelab echo data. Freedom from SVD 100% and PVL 99.5%. Nearly zero >mild transvalvular AI.
@GilbertTangMD
@djc795
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Calling out trainees like this is really unfortunate. Be present. Teach.
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Zone 2 arch and finish with staged single branched TEVAR into subclavian. Definitive graft landing zone, don't go near rec laryngeal n, easier distal anastomosis. Short circ arrest/ACP time takes priority.
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The branched graft era for Type B Aortic Dissection is here! It was a privilege to present the Gore TBE branched graft pivotal trial at the
#STS2023
Late Breaker session. This gives Type B dissection patients a less invasive option for Zone 2 TEVAR while maintaining LSA patency.
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Has anyone else seen a huge drop in aortic emergencies(similar to STEMI) in the past 2 weeks?
@OPreventzaMD
@OuzounianMD
@tomcnguyen
@GilbertTangMD
@DrIribarne
@EricRoselliMD
@HirooTakayamaMD
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Had an amazing time with the amazing
#UofTCardiacSurgery
residents today. The future of Cardiac Surgery in Canada is in great hands!
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One of the best things about going to live meetings is the cultural experiences you get abroad. Had the privilege of attending the opening of the new MOCO modern art museum in Barcelona today. Basquiat, Banksy, Hirst! Fantastic!
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So..surgeons are not in TAVRs for bailout. We have >60yrs of expertise in valve surgery,>20yrs large bore access and CT planning for aortic stents. I wish more surgeons weren't excluded from the table-but this is the norm in most countries, and with it all this knowledge is lost.
@samsaid75
I'm confused...in 🇺🇸 is it a requirement for a ❤ surgeon to be in the cath lab during a TAVI case??
We stopped that years ago in 🇬🇧 as requirement for emergency surgery is so low
Don't the surgeons get bored hanging around for routine TAVI cases?
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When you feel some personal balance, the little professional disappointments don’t hurt you. Your perspective is broader, your goals longer-term.
#CTCareers
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Happy to be heading to Amsterdam for
#esccongress
! Let’s talk some
#aortaed
and connect with old friends!
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Our paper describing the new STS/ACC TVT TAVR Risk Model now published in
@circaha
! Our goal was to develop a patient centric and data driven performance model to help TAVR sites understand the quality of care they deliver and provide a framework to help guide patient choice. /1
#OriginalResearch
: New data from STS/ACC TVT registry shows substantial variations in US
#TAVR
care
@arnoldgehrke
#AHAJournals
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Here’s data from the 2019 STS/ACC TVT National Slide Set available at with annotations by
@BavariaMd
Bottom line - minor improvements in mortality, everything else is flat - even as patients are getting less risky.
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#STS2024
Great STS -EACTS Collaborative Session today on Complex Root procedures! Step by Step Aortic Root Reimplantation beautifully demonstrated by
@OuzounianMD
Tremendous STS program this year by
@KarenMKimMD1
!!
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I think this pretty much sums up the relationship between cardiac surgery and interventional cardiology for the past 40 years... Let’s work better together folks - our patients deserve it.
@DrAmirKaki
@mirvatalasnag
@GreggWStone
@Almanfi_Cardio
@ziadalinyc
@crfheart
Your back and forth read like children arguing with each other
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Great discussion on optimal management of acute Type B Dissection at the
@AATSHQ
#aorticsymposium
today! What is the role of TEVAR in uncomplicated acute type B dissection?
@BavariaMd
@ShinFukuharaMD
@JulieDoberne
#aorta
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Was a great pleasure presenting at the 9th International Aortic Summit this morning! Thanks to Prof. Bashi. V. Velayudhan and the team from India for putting on such an informative meeting.
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More evidence to support Radial artery grafting in CABG. Let’s keep working towards all arterial grafting solutions - the most physiologic approach to coronary revascularization.
Radial artery grafting vs SVG in CABG at 10 years, by Dr Gaudino et al in
@JAMA_current
@WCM_CTSurgery
@STS_CTsurgery
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Dr. Gaia presenting the world's first Endo-Bentall done with transapical approach. While many barriers remain, this early proof of concept is very inspiring for this field to grow.
#EACTS2020
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Ross, Repair, Replacement - understanding options for lifelong management of young patients with aortic valve disease at the
#AVRS
. Record turn out. Pushing the field forward.
@BavariaMd
@OuzounianMD
@MichaelMwachu
@KarenMKimMD1
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We are streamlining all intubation and procedures into discrete teams with attendings present to minimize exposure risk. All intubations done with PAPR by attending anesthesiologists. Let’s minimize risk to the trainees!!!
Great first night on the
@pennsurgery
procedure squad w/ amazing team of vascular surgeons - Jon Quatrimoni + Paul Foley. Thanks to all the amazing RNs/providers/staff who, among so many other things, made sure we were safe & supported.
#teamwork
@PennMedicine
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Fantastic work on the risk of persistent opioid use after cardiac surgery by Penn CT surgery resident
@ChaseBrown_MD
published in
@JAMACardio
today. This is happening in nearly 1/10 cardiac surgery patients and is highly correlated to the amount of opioids prescribed at discharge
Our recent publication on correlation between amount of opioids prescribed after cardiac surgery and risk for persistent opioid use. Multimodal analgesic strategies for postoperative pain are critical!
@NimeshDesaiMD
@PennLDI
@pennsurgery
@STS_CTsurgery
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Discussing quality in
#aorta
surgery at Michigan Society of CT Surgeons Quality Collaborative today. Outstanding data driven analysis by
@KarenMKimMD1
. Overall very solid clinical outcomes across the state. Great to see such a collaborative effort!
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Barcelona - never disappoints! Happy to be here!
#EACTS2021
@EACTS
hybrid meeting starts today at Barcelona. Check out a 👍🏼 3-day program of the latest in CT surgery including endoscopic MV repair, novel Endo aortic surgery and
#TAVR
outcomes in low risk in TVT-R by
@BavariaMd
!
@NimeshDesaiMD
@modine_thomas
@tomcnguyen
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Congrats to my dear friend Wilson Szeto on this honor! Wilson along with innovators like
@OPreventzaMD
, Mat Williams, Grayson Wheatley, the late Michael Davidson and
@EricRoselliMD
created endovascular cardiac surgery–a legacy that will resonate for generations of CT surgeons
Congratulations again to our 2021 Socrates Award winner Dr. Wilson Szeto!
@pennsurgery
@BavariaMd
@NimeshDesaiMD
@jgrizzity
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One of the biggest barriers to further research and adoption of surgical robotics is the total disinvestment from the robotic companies in the cardiovascular space. Even well established techniques like robotic mitral or LIMA takedown receive no support and no technology
Called to the OR for iliac injury during robotic case! We need vascular surgeons who can use robot for repair. That's our job.
@BavareMD
#Vascularrobotics
#SCVS2024
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Aortic valve repair for insufficiency is often highly complex - Master surgeon
@LarsSvenssonMD
breaks down a systematic approach for valve evaluation and repair
@AATSHQ
@AATSED
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Serious issue. CT surgery needs to embrace this wholeheartedly. Our recent paper in JAMA Cards by
@ChaseBrown_MD
showed that 1 in 10 pts end up with persistent opiod use after cardiac surgery. We can move the needle on this and must be fully engaged.
Opioid prescribing is highly variable within the cardiac surgery community. Education is linked to prescription sizes and there is a desire for guidelines in this area.
Thank you to
@cscs_sccc
and this team for helping to coordinate a nationwide effort!
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This was a great team effort:
1: Rapid diagnosis by OB and crit care
2: Realtime virtual assessment by Penn PERT team
@jaygirimd
3: Rapid xfer DIRECT to OR from OSH by
@PENNSTARFlight
using Type A dissection protocol
#pennaorta
4: Rapid resuscitation by
@PennAnesthesia
team.
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Direct to patient Impella marketing? Only in America! Do patients come the lab requesting it?
@djc795
@mirvatalasnag
@ajaykirtane
@jaygirimd
It came on again! Looks like an ad for a phosphodiesterase inhibitor.
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So proud of our trainees and the research collaborations they help us build around the world! In this transatlantic study,
@SelimMosbahi
looked at root-sparing Surgery in acute type A. Main upshot: root > 4cm more likely to need reintervention - but overall rate still low
Glad and honored to bring this president’s choice award back home. It’s a great collaborative project between Philadelphia and Bern focusing on the aortic root in acute type A aortic dissection.
@NimeshDesaiMD
@BavariaMd
@MatthiasSiepe
@John_J_Kelly_MD
#EACTS202
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Looking forward to this tomorrow. We are presenting a series of webinars from experts in the field of complex aortic root repair that illustrate the techniques of Valve-Sparing Root Replacement from basic principles to down to deep granular technical details. /1
Join us for our new Valve Sparing Atlas series, where we aim to cover a wide-range of topics relating to aortic valve & root disease, pre-case planning & treatment options:
@BavariaMd
@NimeshDesaiMD
@HirooTakayamaMD
Register now:
#aortaEd
#aorticsurgery
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I think this bears a little more editorial comment then the headline suggests. The authors state: "effect confined largely to native coronary plaques proximal to the graft anastomosis". Agree with
@djc795
- want the grafts to stay open. But CABG does not progress distal disease.
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Join the Penn Aorta Center tomorrow for an in-depth look at the bicuspid aortic valve, its aortic manifestations and evolving treatment strategies for lifelong management.
#aortaed
#pennaorta
@BavariaMd
Don't miss it👀: Bicuspid Aortic Valve Disease - It's a Root, Not a Valve Disease 🗓️ 09/29/21⚡️Free webinar features
#PennAorta
's
@BavariaMd
&
@NimeshDesaiMD
Register:
#aorticdisease
#aorticsurgery
#aorticaneurysm
#aorta
#aortaEd
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Was a pleasure presenting on Hybrid Arch procedures today at the 48th Annual Meeting of the Japanese Society for Vascular Surgery. It was wonderful to see my Japanese friends again! Hopefully next year we will be in person!
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1/3 of all 30 day deaths after TAVR occur after discharge home. We look into the causes in our recent article in JACC Interventions from the STS/ACC TVT Registry.
In an
@ACCinTouch
/
@STS_CTsurgery
TVT Registry analysis, 30-day all cause mortality after transfemoral
#TAVR
was 2.2%, with 1/3 occurring after discharge to home, predominantly from cardiovascular and
#pulmonary
causes.
@NimeshDesaiMD
@MReardon19
#JACCINT
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Had a great time presenting at STS
#AQO2020
today with Dr. Karen Kim and Data Manager Nancy Honeycutt. Amazing to (virtually) see over 700 Data Managers who have dedicated their lives to improving the quality of care for cardiovascular patients!
@KarenMKimMD1
@STS_CTsurgery
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My take home from FAME 3 is not that all 3VD patients should have CABG but that ALL stable 3VD patients need to see a cardiac surgeon for informed team decision making. This is not happening worldwide. Most should have surgery but there are many factors that go into these choices
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Impressive...
Angitomografía coronaria. Aneurisma gigante de coronaria derecha.
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Happy to be back in the 6! Looking forward to spending the day with so many great friends and brilliant trainees!
Tomorrow
@NimeshDesaiMD
joins us in-person for
#cardiacsurgery
academic rounds to present on innovation, quality and the future of
#aorticsurgery
🫀
@OuzounianMD
@jenn_cy_chung
@UofTCVsurgery
@UofTSurgery
@UHN_Surgery
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Buongiorno from Milano! Excited for the start of EACTS 2022 and seeing FIVE
#PennCTsurgery
trainees on the podium!!
#EACTS2022
#PennAorta
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This field was opened up beyond isolated case reports by the PARTNER trial - surgeons and ICs working together - break that model and really, are you living up to foundations that TAVR was actually built upon?
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We randomized many pts in the PARTNER trials and SURTAVI. The patients randomized to surgery frequently asked to be withdrawn after the first 1-2yrs as they were feeling fine and did NOT receive the experimental treatment. They didn't see the need for all the study echos/visits.
Can someone explain to me how a patient, randomized and treated in a major RCT, can be withdrawn from a KM survival curve?
If a patient is included in a KM, either there is an event or they are censored at latest follow-up. Withdrawn doesn’t exist in the KM. So what happened?
1/
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Wow. Just wow.
Incredible visualization of what leads to electrical alternans with big pericardial effusions
#MedTwitter
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Really? Show us some data to support that. This issue is dead. Heart team, shared decision making and appropriate surgical referral is the answer.
I couldn’t agree more. Using intravascular imaging guidance could’ve completely eliminated the difference between the groups.
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Great action shot of my partner and mentor Dr. Joseph E. Bavaria!
Support our Foundation!
@BavariaMd
@STS_CTsurgery
TSF awarded 109 grants to CT surgeons in 2019! Read testimonials in the 2019 Annual Report. Please help us fund research by donating to TSF. All surgeon donations will be matched by STS starting today.
Donate: AR:
@STS_CTsurgery
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Nice review of our evolving techniques for aortic arch replacement. And a great opportunity to introduce the newest Attending Surgeon on the Penn Aortic Team- Dr. Joshua Grimm!
@jgrizzity
@BavariaMd
@pennsurgery
Our Focused Topic Series for Nov/Dec concludes with an Editorial by Drs.
@jgrizzity
and
@BavariaMd
on the evolving treatment strategies for arch pathologies
#Aorta
#TEVAR
@NimeshDesaiMD
@RKTvascular
@Muha_Aftab
@Dr_Ma_of_PUMC
@monteromiguel
Open access:
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FDA issues warning re: early structural valve deterioration in Abbott Trifecta and Trifecta GT aortic valves.
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@georgetolisjr
Plenty of literature showing risk aversion doesn’t improve your ratings- bad results in low risk patients are much more damaging. We moved to a high risk team model where all high risk cases are discussed among 4+ surgeons to guide strategy, optimize and determine futility
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Calling on all future Cardiothoracic Surgeons! We are having our LIVE information session for the I-6 program on Sunday Sept. 20. We are so proud of our trainees and hope you can join us!
@AspiringCTS
Everyone who's interested in applying to an I-6 CT surgery program this year, Penn will be hosting our virtual information session on Sunday, Sept 20th at 7 PM! Please register at this link and come meet the attending surgeons and the residents at Penn!
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Looking forward to a lively discussion on Bicuspid Aortic Valve repair with VSRR tomorrow with
@BavariaMd
and
@BonnieMilas
. Deep focus on imaging-based planning and complex technical details of an important option for BAV AI patients. Registration details below!
📺 Register now for live discussion + audience Q&A with Dr Nimesh Desai, Dr Bonnie Milas and Dr Joseph Bavaria.
The topics are Imaging Techniques and Analysis for Aortic Valve Sparing Procedures & Valve Sparing and Repair for Bicuspid Aortic Valve.
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Clash of the Titans!
@schaefers_hans
and Tirone David debating Remodelling vs Reimplantation for Aortic Root Aneurysm 🔥
@AATSHQ
#aorta
@OuzounianMD
@EricRoselliMD
@OPreventzaMD
@GilbertTangMD
@FaisalBakaeen
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@rodrigo_md_79
@tomcnguyen
@Jasosamd
@HeartUCSF
@UCSFSurgery
@ucsfhealth
Nice work! Great to see this type of intraoperative imaging in use !!! Here is our original description of the technique in JACC.
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Congratulations
@OPreventzaMD
!! A great surgeon and great friend.
Congratulations to Dr
@OPreventzaMD
on being
@WomenInThoracic
's featured surgeon, nominated by
@JessicaLuc1
!
"Dr. Preventza is a leader in the field, paving the way for women in
#CTSurgery
, and a true inspiration."
Learn more about her & nominate others
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Lots of work to do - innovation doesn’t matter if we can’t bring it to ALL the people who need it. 👇 Proud to collaborate with
@ashwin_nathan
@jaygirimd
@ACFanaroff
on this very important work.
@djc795
@BavariaMd
Thread/
Was the roll out of
#TAVR
in the US equitable?
@PennLDI
senior fellows
@ashwin_nathan
&
@ACFanaroff
(A&A) led work published today in
@CircOutcomes
that answers this:
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Excellent thread on Evaluation and Management of Thoracic Aortic Aneurysms! Would add that aneurysms above 4.5cm should be followed in a multidisciplinary Aortic Surgery Clinic.
Incidental finding of dilated aortic root/ thoracic aortic aneurysm – what should you do?
Fully-referenced thread covering when to intervene, how to follow up and what else to think about
1/n
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Not sure if it’s coincidence but we are starting to see our first mechanical complication of MI in the COVID era... hope there isn’t a deluge coming
@OPreventzaMD
@GilbertTangMD
@HirooTakayamaMD
@tomcnguyen
@djc795
@ajaykirtane
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@M_Pompeu_Sa_MD
@JAMACardio
@OuzounianMD
@jenn_cy_chung
@JCoselli_MD
@AortaSurg
@OPreventzaMD
@ShinFukuharaMD
@BoYangMD
@DrZeigler1
@ChrisMalaisrie
No way to study this with Medicare data - differentiating complicated from uncomplicated type b from Medicare data is not reliable - and using 30d from admission is not consistent with clinical practice.
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@GBisleri
@pomyers
@IHamamsy
@BavariaMd
@Mark_PetersonMD
@schaefers_hans
@OuzounianMD
@RichardWhitloc2
Excellent video! This is the fastest method of resolving malperfusion syndromes. We recently published the Penn experience in over 350 acute Type A patients cannulated this way. Safe, fast, effective.
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Please join us tomorrow for a deep dive into valve-sparing root surgery for Type A Dissection and Marfan Syndrome with
@JCoselli_MD
and
@EricRoselliMD
. We will focus on technical details of the operations. Unique opportunity to hear from two of the world’s best root surgeons!
⚠ Last chance to register!
Watch live discussion + Q&A:
@NimeshDesaiMD
@EricRoselliMD
@JCoselli_MD
Topics: Valve Sparing in the Presence of Type A Dissection & Valve Sparing Strategies for Marfan Syndrome.
#aorticatlas
#aortaEd
#aorticsurgery
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One of the greatest joys of academic medicine is seeing young careers develop.
@NishthaSodhi
came to
#pennaorta
as a premed research student years ago! Now she’s a leader in structural heart intervention! Proud to be a part of her journey!
Grateful for
@BavariaMd
@tavrkapadia
@AlanZajarias
JLasala
@MichaelRagosta
SLim
@GAilawadiMD
@akates1
JSingh HKurz RBach AAmin
@MarcSintek
@DLMann_MD
WSzeto
@jaygirimd
@NimeshDesaiMD
@MartyMleon
@AnkurKalraMD
@WomenAs1
@KendraGrubb
@uvahealthnews
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Valuable new info regarding TAVR in Bicuspid Aortic Valves. In our accompanying Editorial we outline a decision pathway for when to consider TAVR vs SAVR in BAV. In addition to high risk anatomic features such as severe calcification, always consider concomittant aortopathy.
Bicuspid aortic valve stenosis:
Calcified raphe, particularly in comb. w/ severe overall valve calcification, significantly predictive of complications as well as 30-dy, 1-yr & 2-yr mortality following TAVI/TAVR.
#cardiotwitter
@Drroxmehran
@escardio
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Great to see so much multi-specialty engagement and learning happening here! We all do better when we learn from each other!
@NimeshDesaiMD
@AntoniousAttall
@jaygirimd
@nkakouros
@HarryDauerman
@duanepinto
This is the technique that
@jaygirimd
and
@NimeshDesaiMD
mentioned. Initially described by
@DrAliAzizzadeh
For large bore perc axillary access, I preclose with 2 Perclose devices. After removing sheath and tightening sutures I use Rummel tourniquets to aid hemostasis.
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Decreasing opiod use is an important target for improving outcomes after CT Surgery. Tune in for this great webinar by two experts in the field!
On Thurs Aug 27 at 6pm EST - check out this
@STS_CTsurgery
webinar on "Addressing the Cardiac Surgery Opioid Crisis" led by
@TheRakeshArora
@danengelmanmd
@ERASCardiac
#ERAS
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Wishing my dear friend
@jgrizzity
amazing success in his new role. Austin is very lucky!
On today's
#longhornfriday
, we highlight Joshua Grimm, MD, a cardiothoracic surgeon in the Institute for Cardiovascular Health. Learn more about his contributions toward building a fully integrated array of
#heart
and vascular services in Central
#Texas
:
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Excellent new multicenter data on the emerging issue of TAVR explantation from
@GilbertTangMD
. Very relevant as we use TAVR in younger, low risk patients. It can be done safely but can be very technically challenging.
Just presented our EXPLANT-TAVR, best of 2020 abstracts
#TCTConnect
. More to learn about
#TAVR
failure and surgery needed
@TsuyoshiKaneko1
@modine_thomas
@bapat_savrtavr
@igeorge1975
@OPreventzaMD
@OuzounianMD
@BobbyYanagawa
@derrickytam
@NimeshDesaiMD
@drmaisano
@m_taramasso
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Proud to see my fantastic partners Kariyana Milewski and Stephanie Fuller in action!
@pennsurgery
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Prepare your abstracts! Submissions for the 2024
#Aortic
Symposium in New York City will open on 9/25. Get ready to submit your research on
#cerebral
protection,
#dissection
,
#spinal
cord protection, and more to
#Aortic2024
:
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Are endovascular techniques ready for prime time in the proximal aorta? Tune in for Today’s hard hitting EACTS Session:
Endovascular assault to the aortic root, ascending aorta and arch. A clinical reality.
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This is an amazing look at spread of COVID in a restaurant - how do we prevent this as we consider re-opening?
Take a look at this restaurant scene. One person (A1), who had no symptoms, sat down to eat at a restaurant and subsequently infected 9 other people. Five at other tables. We must prevent this as we think about re-opening.
@CDCgov
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@Almanfi_Cardio
All cause mortality was also better with CABG. I don’t think we need to revisit peri-procedural MI definitions do we?
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Excellent and safe method to perform root enlargement procedure. Very critical for placing large SAVR for future V-in-V options. Penn practice is typically to perform pericardial root replacement (definitively prevents coronary sequestration) - but this is a very handy approach!
We developed a new technique, a "Y" incision and rectangular patch to enlarge the aortic annulus by 2-3 valve size without cutting into the MV, RVOT, or LA. it is very effective and safe. Paper published in JTCVS Tech.
CentralFigure.tif
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@djc795
That’s an egregious error... the whole point of censoring is that it is independent to the endpoint of interest!
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@JoChikweMD
@OuzounianMD
@tssmn
Truly one of the best AATS meetings I’ve ever attended. Thank you so much
@OuzounianMD
and
@JoChikweMD
for all of your hard work!
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Very important study on Type A dissection by
@jenn_cy_chung
in
@JACCJournals
. Lifelong surveillance is critical for late survival after Type A. Aortic disease management goes so far beyond the operating room. Also - setting up for the future at the index surgery is crucial.
Loss to follow up and imaging surveillance is a common story. How common? Unfortunately - the vast majority! Read our Ontario population-based study here, just published in JACC:
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@Almanfi_Cardio
19 patients alive at ten years? Median time to structural deterioration 6.7 years with massive competing risk of death.... as a high volume TAVR operator, I’m not sure about conclusions about 10 year durability here.
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Last Chance to apply for Trainee Scholarships for the Aortic Valve Repair Symposium. This is a great chance to learn about the management of Aortic Valve disease and to meet and directly interact with the faculty members. See you in a few weeks!
Last day to apply! Trainee Scholarships available!
@John_J_Kelly_MD
@TSRA_official
@STS_CTsurgery
@JasonHanMD
@OuzounianMD
@NimeshDesaiMD
@PrashanthVall12
@pennsurgery
#aorta
#aorticvalverepair
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@GreggWStone
Stroke after CABG is age dependent- risk in someone this age (with data provided) is incredibly low.
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Please watch for signs of opioid addiction in our teenagers. My dear friend and colleague
@BonnieMilas
bravely shared her experiences losing two children to this worsening crisis and practical ways to recognize the insidious signs from a parents perspective.
If your teenager was addicted to
#opioids
, would you know? It’s harder than you think: I lost both my sons to opioid overdoses. Looking back, every red flag is screaming at me. But I didn't recognize them then.
@BonnieMilas
@PennMedicine
@PennAnesthesia
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Live Now:
@DavidCookeMD
and
@BavariaMd
discussing the research funding opportunities from the
@CTSurgeryFdn
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@GilbertTangMD
@JAMA_current
@igeorge1975
@TsuyoshiKaneko1
@pomyers
@tomcnguyen
@ArnarGeirssonMD
@ShinFukuharaMD
@Hirji1987
@JessicaLuc1
@OuzounianMD
@BadiwalaMD
@OPreventzaMD
@KendraGrubb
@WomenInThoracic
1:4 CT surgeons I know have had neck surgery or severe chronic pain. Proper table height, loupes angle and less headlight key. Also good core strength, stretching and relaxing tension during cases. For those who also do endo cases, it’s a double hit wearing lead frequently.
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This 👇
@georgetolisjr
Learned 30% from operating with giants, 30% from operating with great surgeons you’ve never heard of, and 30% from operating on everything that came through the doors of small, underserved programs with zero back-up and no resources. +/- 10% from errors you never forget.
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Nice approach to standardize Type A dissection nomenclature from our former research fellow Bartosz Rylski!
Dr. Bartosz Rylski gives an interesting overview of a new practical TEM-classification for type A dissection disease.
#EACTS2020
Classification better described here:
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Happy to be discussing QUALITY in Cardiac surgery at the
#STS
AQO today with
@KarenMKimMD1
and many wonderful data managers from around the US. Quality is more than metrics - it’s about a team of highly invested people constantly scrutinizing and improving what we do every day.
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@AortaSurg
@GilbertTangMD
@alaa_gabi
@FahdWaqar
@MarqPatton
@AtiqRehman4
@MoJadelrab1
@mirvatalasnag
@caresans26
@ramzik1971
@PaChapterACC
@mmamas1973
@ShariqShamimMD
@ALodha_md
@dml01451519
@TsuyoshiKaneko1
@OPreventzaMD
@OuzounianMD
TEVAR is better option. We have seen late strokes, loss of seal with plugs/ASD devices in ascending aorta. Using a device made to conform to the unique anatomy of the ascending aorta is best. This is a recent case of PSA we did with Gore ASG.
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@GilbertTangMD
@saia_francesco
@ccijournal
@KHERA_MD
@J_Sathananthan
@djc795
@drnvanmieghem
@azeemlatib
Isn't the problem with BEV here that the pure non-calcified annulus remodels over time and new large PVLs occur? I've inherited a few of these that had no AI even a month post op and had no seal in 30-40% of circumference 1-2 yrs later.
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Excellent review on the Ross Procedure by our fellow
@mikeibrahimmd
So is the Ross back? How do the new reparative paradigms overlap/compete with this strategy?
@BavariaMd
@schaefers_hans
@EricRoselliMD
@IHamamsy
@mikeibrahimmd
@BavariaMd
Agreed! Excellent Editorial by
@mikeibrahimmd
!
An aortic valve is far more than a passive structure. It has unique biologic and hemodynamic features, which can only be matched by a living valve, ie, AV repair or
#Ross
. As surgeons, we need to think long-term for our young pts.
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@djc795
@mirvatalasnag
@Tabaza
@DocSavageTJU
@Babar_Basir
@ShariqShamimMD
@lorenzo2509
@agtruesdell
@aayshacader
@Pooh_Velagapudi
@yaqoub_lina
@Hragy
@jcgeorgemd
@JanzerSean
@Drbankacardio
@chadialraies
@DrNasrien
@ziadalinyc
@SanjogKalra
@GilbertTangMD
@RichardWhitloc2
@igeorge1975
Sometimes it can be difficult to find the LAD but it’s always there... the vein is very thin walled so it’s usually obvious. Easiest way to tell is that veins don’t have plaque. Can also run cardioplegia to help identify direction of flow.. or you could try ICG angiography.
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@georgetolisjr
Lol - most of us in this space operate like crazy and don’t turn away high risk cases. 1990s cardiac surgery is dead.
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@djc795
@dr_benoy_n_shah
@samsaid75
As usual - agree with Dave. The actual text of the NCD is: The heart team's interventional cardiologist(s) and cardiac surgeon(s) must jointly participate in the intra-operative technical aspects of TAVR.
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