Jamie McCabe
@jamiemccabeMD
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University of Washington Interventional Cardiology
Seattle, WA
Joined April 2013
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Simplified Extraction of Atrial Tumor with Targeted Loop Electricity (SEATTLE) Procedure - now in press.
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Successful retrieval and percutaneous removal of a fully everted tricuspid clip after lock line failure. I don’t think this comes out percutaneously without
@ONOCORvascular
’s Ono basket. (No $ conflict for me, just appreciate having this thing).
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First in man 29 mm Sapien 3 Ultra Resilia valve implanted (first 3 actually!). Has the new Resilia leaflet prep technology and the improved, taller skirt seen on the smaller sized Ultra valves. So far so good! With Dr Gabriel Aldea and
@DavidElison1
.
@EdwardsLifesci
@TAVRBot
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More on the perc myxoma removal - Simplified Extraction of Atrial Tumor with Targeted Loop Electricity (SEATtLE) Procedure! Performed with the
@ONOCORvascular
device. Grasping snare through the Ono and both preloaded through the loop of an electrifiable snare. TEE by
@donoxorn
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First in human use of the
@ONOCORvascular
nitinol basket retrieval system, the Ono, to remove a percutaneously excised right atrial myxoma (more on that in a moment). Worked great! with
@ZLSteinberg
&
@DavidElison1
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Excited to announce
@LAzzaliniMD
will be joining the University of Washington faculty this summer. He’ll join
@DrBillLombardi
and
@KateKearney4
in our complex coronary program and lead our interventional research group. Exciting days ahead.
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Congrats to
@HusamNoor1
, Dr. Haitham Amin and the entire team at MKCC in Bahrain for an incredibly successful TMVR workshop - 4 TMVRs, 3 LAMPOONs, a BASILICA/ TAVI, a pvl closure, and a transcaval TAVI in 3.5 days. Thank you for a great experience. Yala habibi!
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The first case in our series of percutaneously removed mitraclips followed by TMVRs now published in JACC Int.
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Some LV pseudoaneurysms are bigger than others. Failed to thrombose with largest ASD occluder due to a small residual crescentic defect. Came back to pack it. 6.5x4cm by CTA
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Minding my own business & ran into this guy who looks like he’s been playing Moses in a community theater for the last 3 months. Was Moses on the Ark? He kept talking about a boat…
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Cats out of the Twitter bag so welcome to DELAWARE (DEliberate Leaflet Augmentation When Anchoring Requires Extra support). The idea is to ⬆️ friction in Ca+ free zones before TMVR in the context of non-circumfrential MAC by piercing & deploying AVP4 across leaflet. more to come
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Want to thank my hosts,
@drptca
and
@mirvatalasnag
for a wonderful couple of days in Jeddah, Saudi Arabia last week. Could not have asked for a kinder or more competent cardiology group at
@KFAFHCards
. Congrats on many great cases.
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We’re opening up a second Structural Heart fellowship position at UW starting 7/1/23. Must have completed ACGME coronary year before starting. Unfortunately can’t sponsor a visa due to timeline constraints. If interested send CV and cover letter to rach2200
@uw
.edu by 11/1.
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Our
#TCT2022
live case crew. Special thanks to the staff that came to work on a Sat. to make it possible: Alyssa & Mike, techs; Kai & Chris & Gina, our RNs; Nitya, CRNA; Paul, our SH coordinator, & all the crew. It takes a village and our staff are 🔥
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In prep for our live TCT case tomorrow, want to disclose a trade secret: always wear your best underwear to your biggest cases. As my fellow
@DavidElison1
succinctly put it, “you don’t want to be uncomfy when things get uncomfy”. Fact.
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Is the definition of burnout ironically wasting precious time responding to well-meaning management who clearly can’t effect change about how tired / frustrated you are in a repetitive ineffectual time-wasting cycle? Asking for a friend.
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One thing about "live cases" mostly moving to a taped format: out-takes! Is it weird that the blunders are the best edutainment I'm capable of? (vid requires sound). These courtesy of China Structural Heart Week 2021 with
@LaraOyetunji
@CJChungMD
&
@loganlvincent
.
#TAVR
@TAVRBot
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Bit of an unusual case from last year just published in JSCAI by our outstanding fellow Connor Tice - Watchman for PVL closure around a mechanical mitral valve. Coils required because the membrane is permeable. Probably should have packed it more but we ran out of the large coils
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The IC version of what my kids want it to look like under the tree tomorrow. Many years of work pictured (notably the melody in SMVR last 8 years before torn leaflet led to severe MR requiring S3).
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Trying out this whole podcast thing. You know, because everyone has an extra 50 minutes in their day and would rather not listen to something actually important.
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The ballooning aspect of balloon-assisted LAMPOON in a calcified anterior mitral leaflet is one of the most visually rewarding scenarios.
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Tried out the
@Philips
Verisight ICE probe for a tricuspid clip case recently. Feels like cheating. But you do need your own
@gb_mackensen
to go all Beethoven with the knobs.
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What do you do with a very big annulus and small LVOT when TMVR is required? Cliff's Notes from our TCT 2023 Live Case from UW featuring SESAME and ARCTIC techniques! with
@gb_mackensen
@CJChungMD
& Gabriel Aldea
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One day until the Seattle Complications Course! Excited to host such an awesome group of faculty and attendees. If you haven’t signed up you’re missing out; but show up & we’ll make space. Tell them Lombardi told you it was ok.
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UW Montlake interventional group retreat. We mostly escaped the room in time (sorta)… Strong tram work.
@KateKearney4
@CJChungMD
@DrBillLombardi
@ZLSteinberg
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Congrats to
@DavidElison1
- the newly minted Structural Heart fellow at
@UWCathLab
for ‘22/23. Big shoes to fill following
@loganlvincent
.
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Thanks
@DrAmirKaki
and the awesome folks who participated in the Detroit Angio Club for hosting me last night. Never easy to share and learn from complications but some great cases presented.
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Uh oh! What would you do with an incomplete calcified mitral band and subsequent mitraclip? You’ll see what we’re going to do for the
#TCT2022
live case from UW at 2 pm EST / 11 PDT! See you there
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Mitral BVF of a 26 mm Sapien in a 27 Mosaic 3 months after it was placed. Gradient dropped from 13 to 5 mmHg. Do you prefer to use True balloons or Atlas Golds for your BVFs?
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There is no program I hate more within Interventional cardiology than Osirix (Epic is currently trying to find someone to hold its beer…). Anyone have a good alternative DICOM viewer for a Mac?
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Thanks, Kashish. Appreciate
#SCAI2024
giving us the opportunity to show the amazing imaging we get from
@gb_mackensen
and the great work of the whole team.
Amazing Structural Live cases at
#SCAI2024
Raj Makkar deploying an Evoque in 20 minutes followed by Jamie McCabe doing a SESAME (made it look so easy) in a Fabry patient
@jamiemccabeMD
@scaielm
@SCAI
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Have used this a number of times in complex cases for better predictive analyses. Still lots to learn but a really interesting product. Congrats to Dasi Simulations!
BREAKING NEWS!!!
I am delighted to announce that the Centers of Medicare & Medicaid Services (CMS) has granted a reimbursement code for our recently FDA cleared product - PrecisionTAVI.
().
This is a major milestone for
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Live case at
#TCT2021
or dinner theatre? Excited for our ViMAC TMVR with LAMPOON at 6 pm EST tomorrow (11/5/21) with
@gb_mackensen
@CJChungMD
@loganlvincent
& Gabriel Aldea. Hope to see you there.
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If you’d like to see the full recording (30 min) it’s here:
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Proud to see two of our former fellows -
@RhianEDavies1
and
@rafhirarihasnotwitter
? - among the 30 recognized future leaders.
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@KateKearney4
is a badass. Among other things, choosing a circ for your TCT live CTO case takes fortitude and a commitment to the educational mission of live cases in general rather than choosing an easier lesion for self-aggrandizement. That’s not a trivial thing. Proud. Proud.
@atunuguntla1
@WomenAs1
@mbmcentegart
@KAlaswadMD
@crfheart
The only thing I know about Cx CTOs is that I never trust them...STAR fortunately with an acceptable result (The patient plans to resume dance lessons next week so we'll see!)
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Thanks, Jaffar. 3 cases now done with impressive hemodynamic stability following clip removal.
When is elasta-clip not enough? When do you need device excision prior to TMVR? FIH demonstration by
@jamiemccabeMD
where the clip risked PVL in the presence of posterior MAC and transcatheter excision with double elasta-clip and Ono basket retrieval was performed. Cool case!
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Live case for PICS coming up 8/31 @ 11:10 EST - mitraclip through a fenestrated fontan baffle for severe regurg of a common AV valve in a R dom AV canal defect with
@ZLSteinberg
@gb_mackensen
Brian Morray & Tom Jones. Hope to see you there!
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Thanks for inviting me! I had a blast.
Superb Talk by
@jamiemccabeMD
- for the Fellow's Invited Guest Faculty talk
@BrighamWomens
on Innovation in Interventional Cardiology
@PinakShahMD
@JKhambhati
@ZaidAlMarzooq
@RaghavG_MD
@kevinjamescroce
@DougDrachmanMD
@NilayPatelMD
@dmahtta
@DrBillLombardi
@KateKearney4
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Sorry all. My account was hacked last night and all prior tweets seem to be deleted. Better than having your bank account hacked, but still annoying. I guess I'll be a PSA for 2 factor authentication...
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Modern day “clover technique” for TR with tricuspid clipping. Image courtesy of
@gb_mackensen
@MitraBot
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Cabbage Patch kids in the 80’s, PlayStation 5 in 2020, BinaxNOW in 2021… every holiday season has its own special “it” gift that your kids just have to have.
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@cardiacpolymath
@djc795
@PradeepYadavMD
@crfheart
Have done a mitral valve in valve from the R IJ for just this reason. Transeptal with a ‘transcaval-like” telescoping micro catheter technique. Pic of the access site at 30 days.
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Tricuspid clip case using the G4 system with imaging by
@gb_mackensen
. Originally recorded for AZNET 2021.
#TEER
#triclip
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Got to say, the Dasi group was so helpful in working up this a very atypical scenario and fundamental to our decision-making here. Does anyone else leverage decision aids to guide complex SH cases?
@jamiemccabeMD
@gb_mackensen
@DavidElison1
@CJChungMD
@DrBillLombardi
@KateKearney4
@UWMedHeart
Thank you
@jamiemccabeMD
to highlight advanced
@Dasisimulations
modeling to screen different scenarios
#TCT2022
#TMVR
#TAVR
@CoulterBME
@OhioStateERIK
@Rev1Ventures
@PradeepYadavMD
@VinodThourani
@CFMLAB_GT
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Does a 1.3% disabling stroke rate in the control arm feel high to anyone else? I think of a disabling stroke as really catastrophic but maybe any stroke diagnosed by an IC is sort of automatically a disabling stroke to neurology?
Michael Mack discuses the believers & non-believers interpretation of PROTECTED TAVR
#TCT2022
Believers: the trial is positive, it reduced disabling stroke (NNT=125). CEP should be considered in all.
Non-believers: the trial is negative, no role for CEP with TAVR.
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Not to steal the reveal, but this was a calcified and severely regurgitant native mitral valve with a large anterior cleft or maybe you’d call it a trileaflet mitral. Person was frail and older. What’s your clip strategy if there is one?
Celebrating
#WorldHeartDay
with a special structural heart case scenario. Let’s start with the first question: which valve is seen in these 3D TEE images taken in an elderly patient? Poll will follow immediately.
@UWMedHeart
@jamiemccabeMD
@ASE360
#echofirst
#ASEiECHOSIG
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Lil’ Don’t Forget to Sign Your Stupid Epic Notes
Your rapper name is "lil" + the last reason you were in the hospital
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Heart transplant a couple years back. Came in sick and team called because “SVC occluded” from Right IJ.
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@djc795
@Almanfi_Cardio
@moiz_hafiz
@HarshGMD
@Gupta_MD
@GilbertTangMD
@JACCJournals
@EleidMack
@KHERA_MD
@GreggWStone
@azeemlatib
@drnvanmieghem
@G_Tarantini01
@EdwardsLifesci
@Edwards_TAVR
@MDT_Cardiac
@nkakouros
We published on this using TVT data and balloon expandable valves. No real differences. Whether or not there are folks who affect outcomes by being more slick than average (with either technique) is a different question.
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Jeez. Things are broken and hard to see a way out. "A bill that would mandate nurse-to-patient staffing ratios is scheduled for a public hearing in the Washington Senate on Feb. 16."
Dear Santa, please provide (frontline) healthcare with more of everything...
49% of
#nurses
in Washington State plan to exit the profession:
68% said short staffing was one of their primary reasons
79% said they were burned out
45% said they feel unsafe at their job
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Fabulous images as always,
@gb_mackensen
Following thorough planning we
@UWMedHeart
are 😁 to report a very successful LIVE case transmission to
#TCT2022
. This complex & inoperable patient presented with severe MR, s/p MV repair, MAC & s/p MitraClip (placed at OSH) & porcelain aorta. Here are today’s BL images
@ASE360
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Not until March but I’m already looking forward to going to this program!
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Great imaging as always for our tricuspid clip.
@MitraBot
Value of Color M-mode of the hepatic veins b4 & after tricuspid TEER with MitraClip to demonstrate holo-systolic flow reversal at baseline & absence of that reversal after successful treatment. 3D color images illustrate reduction of TR to trace.
#ASEiECHOSIG
@jamiemccabeMD
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@SCAI
I almost look like I know something though I’m sure I was saying something more like, “on the one hand, chocolates delicious, but on the other…”
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@GaneshMuthappan
@gb_mackensen
@fmahmood543
@DouglasShookMD
@RichardSheuMD
@NadeenFaza
@PhilippLurz
@SLittleMD
@ASE360
It’s made by Mavik and cost $5k. I know because I bought it for him.
#ICs4Imagers
!
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Such impressive innovators
Intramyocardial “surfing” enables
#MIRTH
but more importantly provides access to the previously unreachable!
@TheBethesdaLabs
@nih_nhlbi
@CathElectroSurg
@AdamGreenbaumMD
#EPeeps
#CardioTwitter
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@VDelgadoGarcia
@gbiondizoccai
@NAjmoneMarsan
@vonBardelebenRS
@DeeDeeWangMD
@hahn_rt
@IcorCat
@hgermanstrias
@EACVIPresident
@DonalErwan
@ASE360
Don’t forget stellar contributions from
@gb_mackensen
from Seattle and
#IsabelKoerber
from Cologne!
@MattiAdam_MD
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@fjsawaya
@GilbertTangMD
@drnvanmieghem
@didier_tchetche
@vonBardelebenRS
@mirvatalasnag
@dmylotte
@stepoco
@drmaisano
I have done this in a rheumatic with severe MR/moderate MS and no options. Didn’t work - leaflets weren’t pliable and gradient with clip on constantly +10. Thankfully BMV didn’t increase MR significantly. Didn’t leave a clip.
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Personally, I think some of these recs could benefit from some more data, esp for THV but w/ established risks & no clear evidence for benefit, I agree w/ the ‘less is more’ concept - it seems to be the theme of 2021 (see MASTER DAPT)
Optimal antithrombotic therapy for valve prostheses from the 2021
#ESC
Guidelines for the management of VHD
#ESCCongress
@escardio
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@TheNarulaSeries
@ONOCORvascular
@donoxorn
We put in a 24 F just to be sure it would work but could have been smaller
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@phillipfreeman
@KFAFHCards
@drptca
@mirvatalasnag
@assiri99
@wagarhabib
@colum_owens
@didier_tchetche
@CuissetDr
@MichaelMegalyMD
@AlkashkariWail
@fjsawaya
@6ayyeboon
@bkolskk
@sbrugaletta
@PCRonline
@KardiologieHH
@aayshacader
@adnanalkhouli
@drsonyaburgess
Thank you. But all i did was sit in the back and sweat in the heat 🥵. No help offered or needed.
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@ekgpdx
@Abraham_Jacob
@satyashreenivas
@JFleitmanMD
@ProvHealth
@TheJHLT
@jason_wollmuth
@AndrewJSauer
@MartyMleon
@djc795
@NavinKapur4
@vbluml
@JasonKatzMD
@ShashankSinhaMD
Non con CT protocol for sizing (manuscript in submission) takes 10 min. Though obviously no one-size fits all and there is clearly a role for every technique sometimes
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@Abraham_Jacob
@satyashreenivas
@JFleitmanMD
@ProvHealth
@TheJHLT
@ekgpdx
@jason_wollmuth
@AndrewJSauer
@MartyMleon
@djc795
@NavinKapur4
@vbluml
@JasonKatzMD
@ShashankSinhaMD
Personally, I’m in the TAVR upfront +\- mcs to follow camp, but just dropping in to remind you tandem doesn’t have to be from the leg and bed rest isn’t obligatory (though that’s probably how it’s easiest).
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@DrAdaStefanescu
@rwyeh
@agtruesdell
@Pooh_Velagapudi
Most issues will be ergonomic. Not really feasible from the left wrt your radiation exposure. From right, use a 45 cm sheath inserted partway and then ioban sheath to abd to create semi-normal sitch. Catheters subsequently have poor backup. Been done but I’m not endorsing.
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@NeerajShahMD
@cardiacpolymath
@djc795
@PradeepYadavMD
@crfheart
Steerable guide from the IJ. 0.035”micro catheter inside that with a 0.014” micro catheter inside that over an Astato wire. Flex and torque steerable guide to establish position. Electriy the astato to puncture. Use micro catheters to upsize to a 0.035” wire.
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@AVishnevsky_MD
@Philips
@gb_mackensen
I’m so glad you noticed! That’s me at my Twitter apex. I’ll see myself out
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@DrMoritzWvB
@gb_mackensen
@igeorge1975
@GilbertTangMD
@mirvatalasnag
@PCRonline
@djc795
@modine_thomas
@pomyers
@drptca
@VDelgadoGarcia
@6ayyeboon
@stefan_harb
@didier_tchetche
@CuissetDr
@cardioPCImom
@Reismanmmd
@UWMedHeart
@RichardSheuMD
@srdjanjelacic
@UWAnesthPainMed
@ASE360
@EGarciaSayan
Forgive me but I don't know what annulopexy is exactly and google takes me only to anoplexy ('ano' as in 'anus') and I regret my search.
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@cardiacpolymath
@ONOCORvascular
Neither. It wouldn’t pull into the sheath but no cutdown required. Pulled it out in the Ono then closed the vein with a figure of 8 stitch. Discharged the following day.
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@DrTomWaggoner
@TweetPimaHeart
Awesome. I’m a big fan of mVSD devices for large leaks. They’re a bit ‘taller’ than ASOs (7 v 3 mm) but very much same concept. All require bigger delivery catheters and deeper pockets ($) than standard plugs but if the gap is large enough, can work great.
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@djc795
@cardiacpolymath
@PradeepYadavMD
@crfheart
It was a few years ago but I believe I went posterior/mid TS. Delivery was simple. Valve loading in LV/LA across the prosthesis.
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@aelsab
@adnanalkhouli
@ChetRihal
@MayraGuerreroMD
@EleidMack
@tjsimard
@DrArgyle
@rajivxgulati
@MayoClinicCV
@yadersandoval
@psorajja
that's innovative and I'm impressed. did you inject abx directly after aspiration? Congrats on pushing the field further.
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@HusamNoor1
@gb_mackensen
It has been an honor and a privilege. Four days of outstanding results in very complex patients. Congratulations!
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@HarryDauerman
So beautifully organized, a long axis of the LAA would be very interesting. Quite curious what you did?
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@RiSanz2020
@ONOCORvascular
We did not cut down, we just pulled it out. I guess I’d say the vein was quite accommodating. Obviously would have been a bigger issue in an artery. Figure of 8 stitch and 4 hrs bedrest was fine.
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@p_grayburn
@AmrMans51210762
@ONOCORvascular
@donoxorn
So far our recurrence rate is 0%! Obviously I don't know what will happen but (assuming surgeons go for clean margins and have less recurrence, which I'm not sure about), I suppose people can choose if they'd rather have a potential second procedure down the road or a thoracotomy
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@PinakShahMD
@necipermis2
@DouglasShookMD
Beauty! Every once in a while, that small residual leak and start causing hemolysis. It might be the most frustrating “successful procedure” sequelae. Any issues here?
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@ekgpdx
@DrJayMohan
If LVOT is small as noted, trial participation maybe a challenge. Depends How much space you can get from ASA alone since LAMPOON is out. If she wants to fly to Seattle, we’re doing a lot of valve in MAC & happy to help
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@gb_mackensen
@UWMedHeart
@ASE360
Reasonable next poll question is, how would you treat it if you knew it was severely regurgitant?
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@agtruesdell
@KateKearney4
@DavidElison1
I wouldn’t mind if I was the same size I was in high school🫣
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@AngioJunkie
Yup, persistent L SVC, swan traversing the coronary sinus to RA. Seemed surprising to me in the context of a heart transplant.
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