Podcasts about cardiovascular surgery

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Mara Antonoff, Associate Professor of Thoracic and Cardiovascular Surgery and Program Director for Education at the University of Texas MD Anderson Cancer Center, and President of Women in Thoracic Surgery, about chest tubes. Chapters 00:00 Intro 02:21 JANS 1, Ross Long-Term Outcomes 04:12 JANS 2, Valve Replacement Pregnancy 07:09 JANS 3, Bronchopleural Fistula 09:36 JANS 4, AUTHEARTVISIT Study 11:51 Career Center 13:56 Video 1, Bicuspid AVR & AAR 16:15 Video 2, Cold Head-Warm Body Perfusion 19:00 Video 3, Dr. Kappetein Podcast 20:23 Dr. Antonoff Interview, Chest Tube Management 38:45 Closing They discuss single chest tube vs double chest tube, the benefits of single chest tubes, and various chest tube sizes. They also explore reducing chest drain pain, stitching the chest tube, and chest tube output thresholds for removal. Additionally, they cover drain removal, air leaks, and clamping.   Joel also highlights recent JANS articles on whether the Ross procedure in young adults delivers favorable long-term clinical and QOL outcomes, a literature review including new data from the registry of pregnancy and cardiac disease III regarding valve replacement during pregnancy, a multi-institutional analysis of the treatment outcomes and prognostic factors in the ESSG-01 study, and the choice of surgical aortic valve replacement type and midterm outcomes in 50 to 65-year-olds.   In addition, Joel explores bicuspid aortic valve repair and ascending aorta replacement, a guide to isolated cerebral perfusion using two bypass circuits, and an episode of The Atrium podcast featuring host Dr. Alice Copperwheat speaking with Professor Pieter Kappetein about the future of revascularization. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Ross Procedure in Young Adults Delivers Favorable Long-Term Clinical and QOL Outcomes  2.) Valve Replacement During Pregnancy: Literature Review Including New Data From the Registry of Pregnancy and Cardiac Disease III  3.) Bronchopleural Fistula: A Multi-Institutional Analysis of the Treatment Outcomes and Prognostic Factors in the ESSG-01 Study   4.) The Choice of Surgical Aortic Valve Replacement Type and Mid-Term Outcomes in 50 to 65-Year-Olds: Results of the AUTHEARTVISIT Study   CTSNET Content Mentioned  1.) Bicuspid Aortic Valve Repair and Ascending Aorta Replacement   2.) Cold Head-Warm Body Perfusion: A Guide to Isolated Cerebral Perfusion Using Two Bypass Circuits  3.) The Atrium: The Future of Revascularization   Other Items Mentioned  1.) Guest Editor Series: Insights Into Pediatric Mechanical Circulatory Support  2.) Cardiac Surgical Arrest—An International Conversation Series    3.) Career Center   4.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This special issue of JACC is dedicated to the essential role of cardiovascular surgery in advancing modern cardiology.

JACC's latest issue features Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC, providing an audio version of his editor's page. This collection of articles on cardiovascular surgery gives us an opportunity to reflect on the essential contributions of our surgical colleagues to the broader cardiovascular community. Read the editor's page here: https://www.jacc.org/doi/10.1016/j.jacc.2025.01.016 and the full issue here: https://www.jacc.org/toc/jacc/85/8

A client had a complex surgical procedure on her heart two weeks prior, but it was conducted by way of a catheter threaded up her femoral artery and aorta. Now, she wants to receive massage again. A quick Google search suggests that it would be OK. Her MT is skeptical and wants to be more conservative. Who is right? Listen on for information about transcatheter aortic valve replacement (TAVR) surgery, using AI to make clinical decisions, and how to get to “yes” for people who have recently had surgery. Host Bio:                    Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.                    Resources:    Pocket Pathology: https://www.abmp.com/abmp-pocket-pathology-app   Braun, L.A. et al. (2012) ‘Massage therapy for cardiac surgery patients--a randomized trial', The Journal of Thoracic and Cardiovascular Surgery, 144(6), pp. 1453–1459, 1459.e1. Available at: https://doi.org/10.1016/j.jtcvs.2012.04.027.   Grafton-Clarke, C. et al. (2019) ‘Can postoperative massage therapy reduce pain and anxiety in cardiac surgery patients?', Interactive Cardiovascular and Thoracic Surgery, 28(5), pp. 716–721. Available at: https://doi.org/10.1093/icvts/ivy310.   Patients Who Stay in Hospital Less Than 3 Days After TAVR Fare Better (no date) American College of Cardiology. Available at: https://www.acc.org/about-acc/press-releases/2019/03/04/13/53/http%3a%2f%2fwww.acc.org%2fabout-acc%2fpress-releases%2f2019%2f03%2f04%2f13%2f53%2fpatients-who-stay-in-hospital-less-than-3-days-after-tavr-fare-better (Accessed: 26 September 2024).   Pressler, A. et al. (2018) ‘Long-term effect of exercise training in patients after transcatheter aortic valve implantation: Follow-up of the SPORT:TAVI randomised pilot study', European Journal of Preventive Cardiology, 25(8), pp. 794–801. Available at: https://doi.org/10.1177/2047487318765233.   Transcatheter Aortic Valve Replacement (TAVR) (no date). Available at: https://my.clevelandclinic.org/health/treatments/17570-transcatheter-aortic-valve-replacement-tavr (Accessed: 25 September 2024).   Wang, A.T. et al. (2010) ‘Massage therapy after cardiac surgery', Seminars in Thoracic and Cardiovascular Surgery, 22(3), pp. 225–229. Available at: https://doi.org/10.1053/j.semtcvs.2010.10.005.   What recovery looks like 6 months after an aortic valve replacement (2023). Available at: https://www.medicalnewstoday.com/articles/6-months-after-aortic-valve-replacements (Accessed: 25 September 2024).   Sponsors:   Anatomy Trains: www.anatomytrains.com    Elements Massage: www.elementsmassage.com/abmp   MassageBook: www.massagebook.com   Books of Discovery: www.booksofdiscovery.com   The American Massage Conference: www.massagetherapymedia.com/conferences    

What if the future of heart surgery didn't involve massive scars and long recovery times? On this episode we'll visit the pioneering world of minimally invasive cardiac procedures through the eyes of Dr. Allan Stewart, Medical Director and Chief of Cardiovascular Surgery at HCA Florida Mercy Hospital. A leading cardiac surgeon, his journey from childhood started with an understanding of mechanics that led to groundbreaking medical innovations. His path is nothing short of inspiring. Dr. Stewart shares the pivotal moments that led him to transform the field, including a captivating Nova episode on pediatric heart transplants, and his many years of practice using minimally invasive techniques. Ever wondered how surgeons tackle the complexities of myocardial bridges? Dr. Stewart takes us on a compelling journey through his unexpected dive into this challenging area while at Columbia University. He explains the intricacies of diagnosing and treating these conditions, and the critical decision-making involved in whether to perform surgeries on a beating heart or with a pump. From ensuring precision to avoid catastrophic complications like cutting the artery, to the difficulty of accurate diagnosis, this segment shines a light on both the art and science of cardiac surgery. Finally, we'll delve into the crucial importance of thorough and precise surgical intervention. Incomplete arterial surgeries can lead to devastating consequences, including the need for complex redo surgeries. Dr. Stewart emphasizes the necessity of proper techniques to prevent complications and stresses the importance of educating both patients and cardiologists about the risks associated with myocardial bridges and inappropriate stent use. Join us for this enlightening conversation, and on a lighter note, I look forward to a future bike ride together in South Florida. Don't miss this episode with one of the field's most innovative minds. To reach Dr. Stewart a voice mail or text message was suggested as best. 917-748-7836 To learn more about Dr. Stewart click on the link: Dr. Allan Stewart Episode Highlights (00:17 - 00:40) Becoming a Leading Cardiac Surgeon (03:55 - 05:37) Assessing Candidates for Thoracotomy (09:50 - 11:27) Minimally Invasive Approach in Surgery (14:20 - 15:46) Advanced Imaging Technology in Cardiology (18:58 - 19:57) Robotic vs Full Heart Surgery (23:01 - 23:52) Successful Artery Surgery Examination (31:15 - 33:04) Traveling for Specialized Medical Procedures Chapter Summaries (00:00) Cardiac Surgeon Discusses Minimally Invasive Procedures Dr. Stewart shares his journey to becoming a pioneer in less invasive cardiac surgeries, emphasizing the importance of minimizing trauma and improving cosmetic outcomes. (05:39) Advances in Myocardial Bridge Diagnosis My journey into addressing myocardial bridges began serendipitously and involves challenges such as diagnosis and surgical techniques. (19:59) Cardiac Surgery Complications and Stress Relief Proper surgical techniques and education are crucial in preventing complications and misdiagnosis of arterial bridges in heart surgery. (33:43) Importance of Complete Artery Surgery Nature's arterial bypass and stent surgeries, complications from incomplete procedures, and importance of thorough intervention.  

Show notes: (1:40) What led Dr. Dzugan to the hormone optimization field? (3:20) Differences in medical approaches between countries (7:21) Pharmaceutical dependency in the U.S. (10:40) Aging and hormonal changes (14:11) Importance of hormone optimization (17:52) Understanding disease causes and treatment (20:38) The necessity of regular blood tests for optimal health (27:01) Cholesterol misconceptions and hormone production (30:29) Statins and cholesterol (37:30) Testosterone and heart health (47:38)  Importance of mimicking natural hormone cycles (49:18) Testosterone, DHT, and hair loss connection (56:07) Outro Who is Dr. Sergey Dzugan?   Sergey A. Dzugan MD, PhD is a world-renowned physician, research scientist, and educator. Within a few years of receiving his MD at Donetsk National University, Ukraine, he became the Chief of Cardiovascular Surgery at the University-affiliated regional hospital. After receiving his PhD, he became a Professor at that University. Upon moving his family to the US, he delved deeply into body chemistry optimization and developed breakthrough treatments for high cholesterol and migraine – for which the Academy of Creative Endeavors (Russia) awarded him the title of Academician.   Dr. Dzugan's expertise in human physiology is recognized worldwide, and he regularly presents at global medical conferences such as the prestigious International Congress on Anti-Aging Medicine as the co-founder and Chief Scientific Officer of the Dzugan Institute of Restorative Medicine.   Dr. Dzugan is the author of 163 publications in medical journals, author of 7 books, holder of 3 patents, and author of 23 articles in health-related magazines. He is a Member of the Editorial Board of the Neuroendocrinology Letters and a Member of the Medical Advisory Board at Life Extension Magazine. Links and Resources: Peak Performance Life Peak Performance on Facebook Peak Performance on Instagram

Editor-in-Chief Eric Rubin and Deputy Editor Jane Leopold discuss research that was presented at the 2024 European Society of Cardiology annual meeting. Visit NEJM.org to read the latest research.

We are excited to bring back part two of our discussion on Robotic Vascular Surgery. Yasong (@yasongyumd) and Eva (@urrechisme) are joined by Dr. Lumsden and Dr. Bavare from Houston Methodist Hospital Show Guests: Alan Lumsden: Chair of Cardiovascular Surgery at Houston Methodist and DeBakey Heart and Vascular Center Charu Bavare: Vascular Surgeon at Houston Methodist and Debakey Heart and Vascular Center Hosts: Eva Urrechaga - Vascular fellow at University of Pennsylvania Yasong Yu - Vascular fellow at University of Chicago Robotic Vascular Surgery Episode 1 with Dr. Judith Lin and Dr. Petr Stadler Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

A 60-ish year-old client with a history of surgery for aortic aneurysm insists—INSISTS—that his 21-year-old massage therapist work with him, in spite of his new onset severe leg pain. What are the practitioner's options in this literally life-or-death scenario? This story, that looks cut-and-dried on the surface, is more complex than it appears. Plus, we get to talk about bulges in the aorta, bleeding ruptures, migrating devices, new surgical innovations, and much much more. Listen in to find out how it all turns out. Resources: Pocket Pathology: https://www.abmp.com/abmp-pocket-pathology-app Ameli, F.M. et al. (1987) ‘Etiology and management of aorto-femoral bypass graft failure', The Journal of Cardiovascular Surgery, 28(6), pp. 695–700. Choi, E. et al. (2021) ‘Risk Factors for Early and Late Iliac Limb Occlusions of Stent Grafts Extending to the External Iliac Artery after Endovascular Abdominal Aneurysm Repair', Annals of Vascular Surgery, 70, pp. 401–410. Available at: https://doi.org/10.1016/j.avsg.2020.06.028. Daye, D. and Walker, T.G. (2018) ‘Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management', Cardiovascular Diagnosis and Therapy, 8(Suppl 1), pp. S138–S156. Available at: https://doi.org/10.21037/cdt.2017.09.17. Endovascular repair of complex aortic aneurysms - Mayo Clinic (no date). Available at: https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/endovascular-repair-of-complex-aortic-aneurysms/mac-20429867 (Accessed: 31 July 2024). Ivancev, K. and Vogelzang, R. (2020) ‘A 35 Year History of Stent Grafting, and How EVAR Conquered the World', European Journal of Vascular and Endovascular Surgery, 59(5), pp. 685–694. Available at: https://doi.org/10.1016/j.ejvs.2020.03.017. Modern History of Aortic Surgery, by Hazim J. Safi, MD | McGovern Medical School (no date). Available at: https://med.uth.edu/cvs/2020/08/25/modern-history-of-aortic-surgery-by-hazim-j-safi-md/ (Accessed: 31 July 2024). Park, K.-M. et al. (2017) ‘Long Term Outcomes of Femorofemoral Crossover Bypass Grafts', Vascular Specialist International, 33(2), pp. 55–58. Available at: https://doi.org/10.5758/vsi.2017.33.2.55. Sponsors: Anatomy Trains: www.anatomytrains.com  MassageBook: www.massagebook.com Elements Massage: www.elementsmassage.com/abmp

This week on Parallax, Dr Ankur Kalra welcomes Dr Marc Gerdisch to discuss a groundbreaking study on reducing opioid use after cardiac surgery. Dr Marc Gerdisch is the Chief of Cardiovascular and Thoracic Surgery and Co-Director of the Heart Valve Center and Atrial Fibrillation Program at Franciscan St. Francis Health. He is a senior partner at Cardiac Surgery Associates and a Clinical Assistant Professor of Thoracic and Cardiovascular Surgery at Loyola University Medical Center in Chicago. Dr Gerdisch shares insights into his research on rigid sternal fixation and enhanced recovery protocols, which have shown promising results in postoperative pain management and patient recovery. In this episode, Dr Kalra and Dr Gerdisch discuss the specifics of the study, including the four-cohort design and the steps taken to expedite opioid-free recovery. Dr Gerdisch also shares valuable advice on overcoming physician inertia and building a strong case for implementing such a programme, including cost-benefit analysis considerations. What motivated the study? How can a holistic approach to cardiac surgery recovery be implemented? What advice does Dr Gerdisch have for our listeners? Sources: Gerdisch MW, et al. Ann Thorax Surg 2024. Rigid Sternal Fixation and Enhanced Recovery for Opioid-Free Analgesia After Cardiac Surgery. DOI: 10.1016/j.athoracsur.2024.06.032 CE Cox. TCTMD 2024. Holistic Approach to Cardiac Surgery Can Sharply Cut Opioid Use. Available at: https://www.tctmd.com/news/holistic-approach-cardiac-surgery-can-sharply-cut-opioid-use. Accessed August 12, 2024.

Interested in cardiac surgery? The training paradigm for cardiac surgery has changed significantly over the past decade and we know may students often struggle when deciding what pathway is best for them. For this episode, we assembled a robust team of attendings, fellows, and residents to discuss their journey as well as some of the research that has been conducted about these different pathways to help guide students navigating this decision.  Hosts:  - Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15 Guests:  - Nick Teman, MD- Assistant Professor of Thoracic and Cardiovascular Surgery, University of Virginia, @nickteman - Jolian Dahl, MD, MSc- Integrated Thoracic Surgery Resident (PGY-6), University of Virginia, @JolianDahl - Lyndsey Wessels, MD- Traditional Thoracic Surgery Resident (CT-1), University of Virginia, @LyndseyWessels  Articles Referenced:  - Pathways to Certification: https://www.abts.org/ABTS/CertificationWebPages/Pathways%20to%20Certification.aspx - Narahari AK, Patel PD, Chandrabhatla AS, Wolverton J, Lantieri MA, Sarkar A, Mehaffey JH, Wagner CM, Ailawadi G, Pagani FD, Likosky DS. A Nationwide Evaluation of Cardiothoracic Resident Research Productivity. Ann Thorac Surg. 2024 Feb;117(2):449-455. doi: 10.1016/j.athoracsur.2023.08.011. Epub 2023 Aug 26. PMID: 37640148; PMCID: PMC10842395 https://pubmed.ncbi.nlm.nih.gov/37640148/ - Bougioukas L, Heiser A, Berg A, Polomsky M, Rokkas C, Hirashima F. Integrated cardiothoracic surgery match: Trends among applicants compared with other surgical subspecialties. J Thorac Cardiovasc Surg. 2023 Sep;166(3):904-914. doi: 10.1016/j.jtcvs.2021.11.112. Epub 2022 Mar 22. PMID: 35461707. https://pubmed.ncbi.nlm.nih.gov/35461707/ For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

C. Randall Harrell, M.D., is the Founder, CEO, and CMO of Regener-Eyes, LLC. With over 40 years of experience, he has become a pioneer and visionary in the field of regenerative medicine. His discoveries and patented platform technologies have led to numerous developments and therapies. Dr. Harrell began his career as a research scientist at Emory University, focusing on immunology. He was recruited by Dr. Michael E. DeBakey, the Father of Cardiovascular Surgery, after medical school to study at the world's largest medical center, the Texas Medical Center. He completed his medical training and directed the large burn and wound unit at the Michael E. DeBakey VA Medical Center in Houston, TX. He was nominated for a Nobel Peace Prize in 2002 for his Medical Mission of Mercy.

This week we review an episode from 2022 in the world of cardiac surgery and pediatric pharmacology when we review a work from Australia on levels of cefazolin during and after surgery. Is there an optimal dose regimen that will achieve proper MIC levels of drug? What should the goal of therapy be in regards to MIC levels? Are there novel means of dosing cefazolin? We speak with pediatric critical care pharmacy coordinator at Mount Sinai Kravis Children's Hospital, Dr. Jessica Frye for the pharmacist's perspective on some of these important questions.https://doi.org/10.1016/j.athoracsur.2022.02.047

We know cardiac surgery can seem a bit daunting on the surface. However, most surgeons will come across cardiac surgery patients at some point whether in the OR, ICU, ED, etc. As the FIRST cardiac surgery specialty team for Behind the Knife, we are excited to bring you episodes focused on high-yield topics to help you navigate common cardiac surgery challenges, discuss relevant literature to help you in practice, and help our listeners feel more comfortable around cardiac surgery patients.  In this episode we'll discuss mitral valve disease. We'll review important physiologic differences in patients with mitral valve disease, the most common surgical approaches to address mitral valve disease, and how to work up and address acute mitral regurgitation due to acute papillary muscle rupture.  Hosts:  - Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15 - Aaron William, MD- Cardiothoracic Surgery Fellow, Duke University, @AMWilliamsMD - Nick Teman, MD- Assistant Professor of Thoracic and Cardiovascular Surgery, University of Virginia, @nickteman Learning objectives: - Understand the physiologic differences that occur with mitral valve stenosis and regurgitation.  - Understand the basic principles of mitral valve repair and replacement strategies.  - Understand the presentation, work-up, and acute management of acute mitral valve regurgitations due to acute papillary muscle rupture/MI.   For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu **Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios.

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Ravi Rajaram, MD, MSC NEOSTAR is a phase 2 trial with multiple arms looking at different combination therapies in the setting of resectable lung cancer. So what results were found from this study? Join in as Dr. Charles Turck discusses this further with Dr. Ravi Rajaram, Assistant Professor and the Clinical Medical Director in the Thoracic Center in the Department of Thoracic and Cardiovascular Surgery, Division of Surgery, at the University of Texas MD Anderson Cancer Center in Houston.

Thank you Khamil Durodola, OMS III, for developing this podcast. Thank you Eric KO, OMS III, for being the sidekick in this production! We review (briefly) high yield information about recognizing delirium questions on the shelf. After that, we discuss questions that have perplexed Dr. Roundy for years and even try to address "time on the pump!" The focus is on risk factors for delirium followed by interesting research being done in terms of Cerebral Oxygenation and Inflammation. We enjoyed our discussion and hope you do too! Thank you to the immortal Jordan Turner for creating the perfect bumper music!

In this engaging episode of "A Life of Flow," we explore the world of vascular surgery through a unique lens: the dynamic between Dr. Vanessa Rubio and her father Dr. Gustavo Rubio. In this fully Spanish episode, we uncover their remarkable journey in medicine, how they've transformed their home into a hub of medical innovation, and their shared dedication to vascular surgery. The episode provides insight into the challenges and rewards of this medical specialty while discussing the latest trends and innovations in the field. Join us for a conversation that underlines the significance of vascular medicine and the special familial connection that drives their passion for it. Follow Life of Flow on Instagram Follow Life of Flow on Twitter Follow Dr. Miguel Montero-Baker on Twitter About Dr. Vanessa Rubio:Dr. Vanessa Rubio, a Medical Surgeon, graduated from the Universidad Autónoma de Guadalajara in 2003. She completed her medical studies with an impressive academic record and pursued diverse international experiences, including an internship in Barcelona and social service in Jalisco. Dr. Rubio specialized in General Surgery at Hospital Valentín Gómez Farías and Angiology and Vascular Surgery at Hospital Civil Fray Antonio Alcalde, both associated with the University of Guadalajara. Her extensive academic contributions include presentations and publications, and she is a member of renowned medical associations. Her dedication to advancing vascular surgery and her commitment to patient care have established her as a respected figure in the medical community.About Dr. Gustavo Rubio:Dr. Gustavo Rubio is a highly accomplished Medical Surgeon with a rich medical career. He obtained his professional degree from the Universidad Nacional Autónoma de México in 1979 and has since held various key positions. Dr. Rubio completed his residencies in General and Cardiovascular Surgery, becoming certified in both fields. He holds specializations in Thoracic Surgery, specifically Cardiac Surgery, and Angiology and Vascular Surgery. Over the years, he has actively pursued academic growth, including international fellowships and specialized training in Endovascular Surgery and Flebology. He is a distinguished member of multiple medical associations and has received recognition for his contributions, such as the "Pioneers in Performance" award in 2013. Dr. Rubio's dedication to the field and commitment to medical excellence make him a respected figure in the world of cardiovascular and vascular surgery.

Dr Joe is a Homeopathic Practitioner, born in Brussels, then living in several different countries before deciding to settle in New Zealand. In this podcast, he shares how he went from working as a surgeon, to discovering natural medicine – and believe me, he has studied pretty much studied every single natural health modality there is. He has also published 11 books and lectured internationally. He'll also be speaking of the Fibonacci series, which has completely revolutionised the “potency problems” many Homeopaths experience. His CV is so unbelievably amazing, that I included it here for listeners to peruse.   Dr Joe's website is www.naturamedica.co.nz and emailed at homeosensei101@gmail.com    Curriculum Vitae. Doctor Joseph Rozencwajg, MD, PhD, NMD, HMD, DO, OMD, DAcup, DIHom, DHerbMed, DNutr, HbT, FBIH, RCHom, MNZIA, MNZAMH, MNNZ, MNZSN. Born in Brussels, Belgium, March 14, 1951 Medical School Université Libre de Bruxelles, Belgium, graduated 1976 Specialty in General Surgery: 2 years at Soroka Medical Center, Beersheva, Israel   4 years various hospitals in Belgium Belgian Specialist Surgeon 1982 Specialty in Thoracic and Cardiovascular Surgery, the University of Alberta, Edmonton, Canada Diploma in Acupuncture, ABMA (Belgian School of Acupuncture for MDs)   Member of the NZ Institute of Acupuncture     Member of the NZ Chinese Medicine and Acupuncture   Society (Registered Acupuncturist)   Member of the NZ Chi-Kung and TCM Association   Certificate from the China Academy of Chinese Medicine     Sciences (Acupuncture and TCM, MEDBOO course)   Oriental Medicine Doctor (OMD) Specialist in Homeopathy:   British Institute of Homeopathy, Diploma, Post Graduate   And Fellowship   Institut Homéopathique Scientifique, Paris   Israel Medical College of Homeopathy   Westbrook University, Aztec, New Mexico, USA   Diploma in Homotoxicology   PhD in Homeopathy, Westbrook University   RCHom New Zealand     Specialist in Phytotherapy (Herbal Medicine):   The School of Phytotherapy, UK  Member of the NZ Association of Medical Herbalists Diploma in Nutrition: the International Academy of Nutrition, Australia Diploma in Applied Clinical Nutrition (USA) Fellow of the American College of Applied Clinical Nutritionists Diploma in Homeobotanical Therapy, Australia Post-Graduate Diploma of Dynamic Phytotherapy  Doctor in Naturopathy (UNM/YINS) PhD in Natural Health Sciences (UNM/YINS) Doctor in Oriental Medicine (OMD, Calamus International University) Doctorate in Osteopathy (Drugless) (D.O.) Permanent student in Ortho-Bionomy Student in Cranio-Sacral Therapy Student in Visceral Manipulation Advanced Dorn Method Practitioner Miscellaneous: Auriculotherapy, Bach Flower Remedies, Aromatherapy,    Reflexology, Iridology, Reiki Master (Usui), MPRUE Great GrandMaster Practitioner and Instructor in Tai Chi and Qigong. Former Lecturer in Medical Diagnostics at the Faculty of Chiropractics and Homeopathy, Technikon Natal, Durban, South Africa. Former Lecturer in Homeopathy at the Israeli Medical College of Homeopathy. Former Tutor with the British Institute of Homeopathy (Homeopathy, Anatomy & Physiology, Pathology, Diagnostics and Nutrition) Professor of Natural Medicine at Calamus International University Publications: - Dynamic Gemmotherapy. Integrative Embryonic Phytotherapy. - Organotherapy, Drainage and Detoxification. - Removing the guesswork from potency selection: the Fibonacci Potencies series (paper). - The Fibonacci Series: update, discussion and conclusions (paper). - The Potency. Advanced prescribing in homeopathy: the Fibonacci Series. - Third Millennium Homeopathy - Homeopathy and Mental Health Care: Chapter 16 of this Anthology - Homeopathy through the Chinese looking glass: Homeosiniatry revisited - Elementary Nutrition for Homeopaths - Elementary Human Nutrition for Health Practitioners   Non-Medical qualifications: Diploma of Creative Writing from the NZ Institute of    Business Studies. Certificate in Mauri Ora (Maori studies) from Te Wananga O Aoteaora   First Dan Black Belt Aikido   Second Dan Black Belt Karate   Tai Chi Chuan and Qigong Practitioner   Yoga Student/Practitioner

Danayal Zia for Friday's show from 4-6pm where we will be discussing: “World Heart Day" and "Absolute Justice" World Heart Day On World Heart Day, individuals and communities come together to promote heart-healthy lifestyles through exercise, balanced nutrition, stress management, and smoking cessation. Join us as we embark on a meaningful discussion of heart health. Absolute Justice Addressing injustice is an ongoing global challenge. It requires the collective efforts of individuals, communities, organizations, and governments to promote equality, human rights, and social justice. His Holiness Hazrat Mirza Masroor Ahmad (may Allah be his helper) has been educating and warning the world for the past 2 decades that in order to achieve such a world where the rights of all are taken into consideration we must turn to our creator. It is only when we realize and fully comprehend that there is a God who will question us for our actions in this world that we will be able to create a world based on absolute justice. Guests: Ruth Goss - Senior Cardiac Nurse, British Heart Foundation Dr. Mubashar Mumtaz - Cheif of Cardiovascular Surgery, Surgical Director Structural Heart Program from Harrisburg, Pennsylvania - USA Dalhia Campbell - Freelance dietitian and part time in the NHS. She is a British Dietetic Association Media spokesperson and has over 25 years experience as a dietitian. Producers: Farah Mirza and Raza Ahmed

Join Chris Knoll and Lillian Su, 2 cardiac intensivists at Phoenix Children as they interview Dr. Jim DiNardo who is the former Chief of CV Anesthesia at Boston Children's. We recorded live at the spectacular 8th World Congress of Cardiology and Cardiovascular Surgery in DC and Dr. DiNardo's sessions were standing room only so he shares insights from not only the sessions but also reflects back on his illustrious career. Lots of wisdom in this 2 part episode, including thoughts on microcirculation, milrinone, optimal peep, what makes a great surgeon and much more! Part 2 will be released in early October. Hosts: Chris Knoll, MD and Lillian Su, MD both at Phoenix Children's Hospital. Guest: Dr. James DiNardo, MD (Boston Children's Hospital). Editor and Producer: Lillian Su, MD

In this episode of Run with Fitpage, we have one of the top Heart Surgeons in the country, Dr Adil Sadiq. Vikas and Dr Adil dive deep into some of the most prominent reasons behind Coronary Artery Disease and ways to prevention.Dr Adil Sadiq is a renowned cardiac surgeon in Bangalore with over 4500 cardiac surgeries, 1600 thoracic procedures, and 65 heart and lung transplants under his belt. He is one of the few surgeons in India who is trained in robotic cardiac surgery and has extensive experience in minimally invasive cardiac surgery. He is currently the Senior Consultant and Head of Cardiothoracic and Vascular Surgery at Sakra World Hospital in Bangalore.Dr Sadiq completed his undergraduate medical degree from Bangalore Medical College and his master's degree in general surgery from Kasturba Medical College, Manipal. He then went on to pursue his super-specialty training in cardiothoracic and vascular surgery at the prestigious Sree Chitra Institute. Dr Sadiq is a highly skilled and experienced cardiac surgeon who is passionate about providing his patients with the best possible care. He is a member of several professional organizations, including the American College of Surgeons and the Society of Thoracic Surgeons. He is also a recipient of several awards, including the "Service Excellence in Cardiovascular Surgery" award from the Times Health Excellence 2018 event.Reach out Dr Adil here: sakraworldhospital.com/doctors/dr-adil-sadiq-institute-of-cardiac-sciences/11About the hostVikas hosts this weekly podcast and enjoys nerding over-exercise physiology, nutrition, and endurance sport in general.  He aims to get people to get out and 'move'.  When he is not working, he is found running, almost always.  He can be found on nearly all social media channels but Instagram is preferred:)Reach out to Vikas:Instagram: @vikas_singhhLinkedIn: Vikas SinghTwitter: @vikashsingh1010Download Fitpage App: fitpage.in/the-all-new-fitpage-app/Subscribe To Our Newsletter For Weekly Nuggets of Knowledge!

We know cardiac surgery can seem a bit daunting on the surface. However, most surgeons will come across cardiac surgery patients at some point whether in the OR, ICU, ED, etc. As the FIRST cardiac surgery specialty team for Behind the Knife, we are excited to bring you episodes focused on high-yield topics to help you navigate common cardiac surgery challenges, discuss relevant literature to help you in practice, and help our listeners feel more comfortable around cardiac surgery patients.  In this episode we'll discuss common cardiac surgery post-op problems. Whether you're on a cardiac surgery rotation or just covering an ICU with cardiac surgery patients for the night, these common post-op problems are bound to occur. Hosts:  - Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15 - Aaron William, MD- Cardiothoracic Surgery Fellow, Duke University, @AMWilliamsMD - Nick Teman, MD- Assistant Profressor of Thorasis and Cardiovascular Surgery, University of Virginia, @nickteman Learning objectives: - Understand the workup and management strategies for post-operative bleeding in the post-cardiac surgery patient.  - Understand how to recognize and manage post-cardiotomy cardiogenic shock in the post-cardiac surgery patient.  - Understand the workup, short-term, and long-term management for post-cardiac surgery atrial fibrillation.  Helpful Resources: - 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000665 - 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures, Executive summary: https://www.jtcvs.org/article/S0022-5223(14)00835-6/fulltext For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our 4 Part Cardiac Surgery Crash Course Series here: https://behindtheknife.org/podcast/cardiac-surgery-crash-course-series-episode-1-intro-to-the-cardiac-or/

Robotic heart surgery sounds like a thing of the future. It is important to know that your surgeon is still the one performing the surgery and he or she is using the robot as a tool. As you might imagine, this requires your surgeon to have a specific set of skills. Dr. Marc Gillinov, Chair of the Department of Thoracic and Cardiovascular Surgery at Cleveland Clinic, answers some common questions about training that surgeons receive and questions you should ask your surgeon if you are considering a robotically assisted approach for heart surgery.

In this episode, our hosts Can Gollmann-Tepeköylü and Miia L Lehtinen, chat to Prof. Dr. Friedhelm Beyersdorf, eminent cardiothoracic surgeon and past-President of the EACTS (2021 – 2022), about his career - how he got to where is today, the challenges he faced along the way, and his thoughts on the future of cardiothoracic surgery.  Guest Speaker:  Prof. Dr. Friedhelm Beyersdorf was born in Bochum, Germany and is a graduate from the Wolfgang-Goethe-University in Frankfurt/M. with clinical clerkship at Johns-Hopkins in Baltimore and Thomas Jefferson Medical College in Philadelphia. His residency was at Johann Wolfgang Goethe-University Frankfurt and University of California Los Angeles. From 1994 - 2022 he was Professor and Chairman of the Dept. of Cardiovascular Surgery in Freiburg, Germany.

For patients with heart valve disease who need a replacement, the choice between a bioprostetic (tissue) or mechanical valve can be challenging. Dr. Marc Gillinov, Chairman of the Department of Thoracic and Cardiovascular Surgery, explains the good, the bad, and the ugly for each type of valve.

Your Real Champion®:  Keep Calm and Love a Tow Truck Driver!

On Saturday, February 18, our host Dr. Marianne T. Ritchie chatted with national expert Dr. Nimesh Desai, a Cardiovascular Surgeon from Penn Medicine about the latest information in cardiovascular surgery.More: https://yourradiodoctor.net/

Radiation Heart Disease Guest: Juan A. Crestanello, M.D. Host: Malcolm R. Bell, M.D. Joining us today to discuss radiation heart disease is Juan A. Crestanello, M.D., professor of surgery and Chair of Cardiovascular Surgery at Mayo Clinic in Rochester, Minnesota. Tune in to learn more about cardiac disease found in younger patients who have had radiation therapy, radiation heart disease. Specific topics discussed: What are the most common manifestations of radiation heart disease? What type of tumors are treated with mediastinal radiation (breast cancer, lymphomas, lung cancer)? How many years after radiation does it manifest? What are the implications for surgery? What are the implications for life expectancy on patients with radiation heart disease? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

A common question our heart doctors get asked is "Can I do anything to prevent a leaky heart valve or anything to keep it from getting worse?" Dr. Marc Gillinov, Chairman of the Department of Thoracic and Cardiovascular Surgery, explains that a leaky heart valve cannot be prevented and that routine monitoring is a great way to catch if it becomes worse.

Hey Clerk Commuters! Is your surgery block coming up? Are you interested in pursuing a career in surgery? In this episode, we interview the Division Head and Program Director of Cardiovascular Surgery at St. Michael's Hospital and Associate Professor in the Department of Medicine at The University of Toronto, Dr. Bobby Yanagawa. Tune in for our discussion with Dr. Yanagawa about tips for succeeding in your surgery block and advice for pursuing a career in surgery.Check us out on Instagram and Facebook for updates about upcoming episodes!The Clerk Commute Podcast | FacebookThe Clerk Commute Podcast

On Episode 22 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the November 2022 issue of Stroke: “Estimating Perfusion Deficits in Acute Stroke Patients Without Perfusion Imaging” and “Five-Year Results of Coronary Artery Bypass Grafting With or Without Carotid Endarterectomy in Patients With Asymptomatic Carotid Artery Stenosis.” She also interviews Dr. George Ntaios about his article “Incidence of Stroke in Randomized Trials of COVID-19 Therapeutics.” Dr. Negar Asdaghi:         Let's start with some questions. 1) What is the actual incidence of stroke after COVID-19? 2) In the setting of acute ischemic stroke, can the volume of ischemic penumbra be estimated with just a regular MRI study of the brain without any vascular or perfusion imaging? 3) And finally, can a patient with significant carotid stenosis go through coronary artery bypass graft surgery? We're back here to answer these questions and bring us up to date with the latest in the world of cerebrovascular disorders. You're listening to the Stroke Alert Podcast, and this is the best in Stroke. Stay with us. Welcome back to another issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. The November issue of Stroke is packed with a range of really exciting and exceedingly timely articles. As part of our Original Contributions in this issue of the journal, we have a post hoc analysis of the Treat Stroke to Target, or the TST, randomized trial by Dr. Pierre Amarenco and colleagues. We've talked about this trial in our past podcast, and the main study results that were published in New England Journal of Medicine in January of 2020. TST randomized patients with a recent stroke or TIA to either a low target of LDL cholesterol of less than 70 milligram per deciliter or a target LDL of 90 to 110. The main study showed that the low LDL target group had a significantly lower risk of subsequent cardiovascular events without increasing the risk of hemorrhagic stroke. So, from this, we know that achieving a low target LDL is possible and is actually better than the LDL target of 90 to 110 post-stroke. But in the new paper, in this issue of the journal, in a post hoc analysis of the trial, the TST investigators showed that it's not just achieving that magic low target LDL of less than 70 that's important in a reduction of cerebrovascular disorders, but it's also how we achieve it that determines the future of vascular outcomes. So, in this analysis that compared patients on monostatin therapy to those treated with dual cholesterol-lowering agents, that would be a combination of statin and ezetimibe, and showed that in the low LDL target group, only those patients treated with dual therapy had a significant reduction of subsequent vascular events as compared to those in the higher LDL category. But the same was not true for patients on statin monotherapy, even though they had all achieved a low target LDL. Think about this for a moment. Both groups, whether on statin monotherapy or on dual anti-cholesterol treatments, achieved the same low target of LDL, but only those on dual therapy had a lower risk of subsequent vascular events as compared to those that were in the higher LDL target group. Very thought-provoking study. In a separate paper by Dr. Shin and colleagues out of Korea, we learned that survivors of tuberculosis, or TB, are at a significantly higher risk of ischemic stroke than their age- and risk factors–matched non-TB counterparts. The authors used data from the Korean National Health Insurance Services and studied over 200,000 cases diagnosed with TB between 2010 and 2017 and compared them to a pool of over one million non-TB cases for matching. And they found that the risk of ischemic stroke was 1.2 times greater among TB survivors compared to matched non-TB cases after adjusting for the usual confounders, health behavioral factors, and other comorbidities. Now, why would TB increase the risk of stroke? The authors talk about the pro-inflammatory state of this condition, thrombocytosis, that is a known complication of chronic TB amongst other putative and less clear mechanisms. But what is clear is that findings from a large-scale population-based cohort such as the current study support an independent association between TB and ischemic stroke. As always, I encourage you to review these papers in addition to listening to our podcast today. My guest on the podcast today, Dr. George Ntaios, joins me all the way from Greece to talk to us about the much discussed topic of the risk of stroke in the setting of COVID-19. Dr. Ntaios is the President of the Hellenic Stroke Organization and an experienced internist who has been fighting this pandemic in the front lines since the beginning. In an interview, he talks about his recently published paper, his experience, and the lessons learned on balancing scientific rigor against the urgency of COVID-19. But first, with these two articles. In the setting of a target vessel occlusion in patients presenting with an acute ischemic stroke, distinguishing the ischemic core from the ischemic penumbra is of outmost importance. The success of all of our reperfusion therapies heavily lies on our ability to differentiate between the tissue that is already dead, which would be the ischemic core, from the tissue that is not dead yet but is going to die unless revascularization is achieved. That is the ischemic penumbra. Over the past two to three decades, there's been lots of debate over how these entities of dead tissue versus going-to-die tissue are best defined, especially when we're making these distinctions under the pressure of time. We don't even agree on the best imaging modality to define them. Should we rely on CT-based imaging? Do we stop at CT, CT angiogram? Should we do single-phase CTA or multiphase CTA? When do we perform CT perfusion, and what perfusion parameters best define core and penumbra, or should we rely on MRI-based modalities altogether? These questions have all been asked and extensively studied, which is why, as a field, I think, we have at least some agreements today on the basics of core and penumbra definitions. And I also think that overall we are becoming better at doing less imaging to be able to predict tissue outcomes in real time. And there's definitely a growing interest in trying to estimate tissue fate based on a single-imaging modality. So, I think you're going to find an Original Contribution in this issue of the journal, titled "Estimating Perfusion Deficits in Acute Stroke Patients Without Perfusion Imaging," really interesting. In this paper, Dr. Richard Leigh from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, in Bethesda and colleagues evaluated patients with acute ischemic stroke enrolled between 2013 to 2014 in the NINDS Natural History of Stroke study. A little bit about the study: It enrolled stroke patients presenting to three hospitals in Washington, DC, and Maryland with serial MRI scans during the acute and subacute time period after ischemic stroke. For this particular paper, they included patients who received MRI and perfusion-weighted imaging and included only those who were thrombolized. That was their way of ensuring that all patients in their study were in the hyperacute stage of stroke. They then looked at their MR imaging, specifically the fluid-attenuated inversion recovery, or FLAIR, images, for a presence of something called hyperintense vessels in the ischemic territory. Now, this is an audio-only podcast, so unless you're Googling FLAIR hyperintense vessels on MRI, to follow along, I have to take a bit of time explaining this entity. What do we mean by FLAIR hyperintense vessels? We are not just talking about the T2 hyperintense signal that's sometimes noticeable at the site of proximal occlusion. For example, in the setting of an M1 occlusion, we may be able to detect a T2 hyperintense signal at the site of M1 on FLAIR. That's not the point of this paper. The point is to look throughout the area supplied by that said target occlusion, in this case all of the MCA, and see whether there is hyperintense signal in all arteries in that potentially ischemic tissue and how the area delineated by these FLAIR hyperintense vessels could potentially correspond to the area of perfusion deficit on conventional perfusion imaging. It turns out that these hyperintense vessels actually map a pretty large area. So, this is the point of this study. The investigators developed a FLAIR hyperintense vessel scoring system and called it NIH, obviously, because this was a National Institutes of Health study, FHV, which stands for FLAIR hyperintense vessel, scoring system. And the score is based on presence of these hyperintense vessels in three vascular territories: ACA, MCA, or PCA. Now, seeing that MCA is a larger territory, they had to further divide it into four sub-regions: frontal, insular, temporal, and parietal. So, in total, we have six regions now. Each of them would get a score of zero if there were no hyperintense vessels in them, and a score of two if there were three or more FLAIR hyperintense vessels in a single slice, or if there were three or more slices that contained FLAIR hyperintense vessels. And, of course, a score of one would be anything in between. So, we have six regions in total, each maximum getting two points, to give us a composite score of maximum 12 for this scoring system. So, they wanted to see whether there's a correlation between the FLAIR hyperintense vessel score and the volume of perfusion deficits that is detected by conventional perfusion imaging, which is their main study result. But before we go there, it does seem like a lot of work to learn all these regions and count all these hyperintense vessels in these six regions and come up with an actual score. So, they had to do an interrater reliability to see how easy it is to score and how reliable are these scores. So, they had two independent reviewers for their study. On average, the scores of these two independent reviewers differed by one point for a κ of 0.31, which is quite a low interrater reliability. But when they looked at a more liberal way of assessing interrater reliability, where partial credit was given, when the raters were at least close in their scoring, the κ improved to 0.65 for a moderate degree of agreement. So, what that means is that it's not easy to learn the score, and potentially I can give a score and another colleague can give a different score. So, we have to keep that in mind. But I want to emphasize that in the field of stroke neurology, we are kind of used to these poor interrater reliability agreements in general. For example, the interrater reliability of the ASPECTS score, a score that is commonly used in our day-to-day practice, and especially in the acute phase, we communicate the extent of early ischemic changes by using the ASPECTS score, has a pretty poor interrater reliability, especially in the first few hours after the ischemic stroke. So, we can make due with a κ of 0.65. Now on to the results of this study. They had a total of 101 patients. Their median age was 73. The median FHV, which is that FLAIR hyperintense vessel score, in their entire cohort was four. And close to 80% of patients enrolled in their study had some perfusion abnormalities on their concurrent perfusion-weighted imaging. Now, briefly, they defined perfusion deficits as areas with delay in the relative time to peak map, or TTP maps, after applying a six-second threshold to these TTP maps. Of note, half of those patients with a perfusion deficit had a significant perfusion deficit, which meant that they had 15 cc or more of perfusion deficit. OK, now on to the main study results. Number one, the score obtained by NIH FLAIR hyperintense score highly correlated with the volume of perfusion deficit. In fact, every one point increase on the NIH-FHV score was approximately equal to 12 cc of perfusion deficit. That's a really useful way of thinking about this score. Each score translated in 12 cc of perfusion deficit. Number two, when they looked at the predictive ability of this score in predicting the presence of significant perfusion deficit, that is 15 cc or more of perfusion delay, the area under the curve was 0.9, which is quite high. This is quite reassuring that the FHV score was sensitive and specific in predicting the presence of significant perfusion deficit. Next finding, how does this score do in predicting a significant mismatch? They calculated mismatch ratio by dividing the perfusion volume to that of ischemic core as measured by diffusion volume as it's done conventionally, and then did the same for the score with the exception that instead of using the perfusion volume, they actually used this score and divided it by diffusion volume. And it turns out that FLAIR hyperintense mismatch ratio had a strong predictive capability in predicting the mismatch ratio of 1.8. So, in summary, if this score is validated in larger studies, it can potentially be used as a quick and dirty way of calculating the amount of perfusion deficit in the setting of target vessel occlusion. And, of course, it can also be used as a predictive way of presence of significant perfusion deficit, which is perfusion deficit of over 15 cc. This is all without the need to do actual perfusion imaging. Now, all we've got to do is to get comfortable with this scoring system and, of course, be able to multiply it by 12 to give us a quick guesstimate of the perfusion volume. And one final word on this is that I think the future of stroke imaging is not in doing more images, but to be able to extract more information from less imaging in the acute setting. Stroke physicians were frequently consulted to see patients that are scheduled to undergo coronary artery bypass graft surgery, or CABG. The stroke consult would be for the optimal perioperative management of an often incidentally found carotid disease. Now, why do I say we were frequently consulted? Because at least anecdotally in my own practice, I feel that over the past decade, the number of these consults has substantially reduced. Why is that? Well, let's dive into this topic and review some of the literature. First off, around 40% of patients who have active coronary artery disease and are scheduled to undergo CABG have concurrent carotid disease, and about 10% of CABG patients have evidence of hemodynamically significant carotid disease. And seeing that the risk factors for coronary artery disease are similar to those causing carotid disease, these high percentages are not surprising at all. But the question to ask is, can we put a patient with significant carotid disease through cardiac surgery? What is the perioperative risk of stroke in this situation? And importantly, should the carotid disease be surgically treated during carotid surgery? This is referred to as synchronous carotid endarterectomy, or CEA plus CABG. Or the carotid disease should be treated either surgically or endovascularly before CABG? We refer to this as staged carotid surgery or post-CABG. This is known as reverse staged carotid surgery. All of these questions are asked from the stroke physicians in that consult, and, like many of you, I have struggled to find the evidence to answer some of them. So, let's briefly review some of the current literature on this topic. The CABACS trial, the acronym stands for the Coronary Artery Bypass Graft Surgery in Patients With Asymptomatic Carotid Stenosis, was a randomized controlled trial that included patients undergoing CABG who are found, exactly like that consult, to have an asymptomatic carotid disease of equal or greater than 70% stenosis. The carotid disease for this trial had to be amenable to carotid endarterectomy, or CEA, and the patients were randomized to either receive synchronous CEA plus CABG or just go through with the CABG alone. The trial started in 2010 and planned to enroll over a thousand patients, but was stopped, unfortunately, prematurely in 2014 due to slow recruitment and withdrawal of funding after only 129 patients were enrolled from 17 centers in Germany and Czech Republic. The original study was published in this journal in 2017. So, what did it find? In their intention-to-treat analysis, the primary outcome of any stroke or death at 30 days was 18% in patients receiving synchronous CEA plus CABG as compared to only 9% in patients receiving isolated CABG. Ouch, a double risk of stroke in those who had concurrent surgical treatment of their carotid disease in addition to CABG. Now, this was an underpowered study, and the results should be understood in that context, but it really didn't appear that synchronous CEA plus CABG would decrease the rate of stroke in the first 30 days. Now, how about the long-term outcomes of these patients? We know that asymptomatic carotid disease carries a cumulative annual risk of stroke, and it's important to see if the risk of subsequent stroke was lower downstream if the carotid was already fixed early on. So, in the current issue of the journal, the CABACS trial investigators, led by Dr. Stephan Knipp from the Department of Thoracic and Cardiovascular Surgery in Essen, Germany, and colleagues are back with the five-year results of this trial. How did synchronous CABG plus CEA do as compared to CABG alone? Well, by five years, the rate of stroke or death was 40% in the combined group and 35% in the CABG-only group. This was not a statistically significant difference. Now, when they broke down the primary outcomes, the rate of death from any cause was similar in the two groups. By five years, the mortality rate was 25% in the combined group and 23% in the CABG-only group. And the same was true for the rate of nonfatal strokes. And also the cumulative rate of nonfatal strokes from year one to year five was similar between the two groups, which meant that the higher stroke risk early on in the CABG plus CEA group was not counterbalanced by decreased rate of stroke later on during the long-term follow-up. And finally, they looked at the rate of disability-producing stroke. First of all, after the first year, no new disabling strokes were observed in either group. That's great news. However, in the early period, unfortunately, close to half of strokes that had happened after the combined CEA and CABG were disability-producing, and about a third of strokes that happened after CABG alone were also disability-producing. So, in summary, even though this study is quite underpowered, it appears that performing synchronous CEA plus CABG increases the preoperative morbidity and mortality in patients with asymptomatic carotid disease without providing any long-term benefits to these patients. Coronaviruses are important human and animal pathogens. By now, I think it's safe to say that most of the population of the world has heard of at least one of the members of the coronavirus's family, which was first identified in late 2019 as the cause of a cluster of cases of pneumonia in Wuhan, China. In the early months of 2020, COVID-19, the disease caused by this novel coronavirus, would rapidly spread to involve much of the world. And on March 11 of the same year, the World Health Organization declared COVID-19 a pandemic. Today, over two and a half years have passed since that day, and an avalanche of scientific papers have since been published about COVID-19, not just in medicine, but in each and every imaginable field of life. Neurology's, of course, no exception. The clinical presentation of COVID-19 largely depends on the severity of the disease and may range from a simple asymptomatic infection to a severe, lethal, multi-organ disease. In the world of neurology, a myriad of neurological symptoms, from loss of sense of taste and smell to headache, all the way to encephalopathy and seizures, have been reported in association with this disease. Early in the pandemic, some studies suggested that COVID-19 is indeed a risk factor for stroke. Like many severe infections, COVID-19 can potentially cause a prothrombotic state and can be associated with thromboembolic events. But most of these earlier studies were smaller observational studies that were completed in an inpatient setting, including those with severe COVID. In fact, to date, we still don't have an accurate and reliable estimate of stroke incidence among patients with COVID-19. On the other hand, stroke is the second leading cause of death globally and the fifth cause of death in the US. In the United States, every 40 seconds, someone has a stroke, and every four minutes, someone dies of a stroke. So, I think the question that everyone should be asking is, has COVID-19 changed this statistic? In this issue of the journal, in the study titled "Incidence of Stroke in Randomized Trials of COVID-19 Therapeutics: A Systematic Review and Meta-Analysis," Dr. Ntaios and colleagues aim to get us a step closer to answering this very important question. Dr. Ntaios is an Associate Professor of Medicine at the University of Thessaly in central Greece, and he's the current President of the Hellenic Stroke Organization. It is my great honor to have Dr. Ntaios today in our podcast to discuss this paper and all things stroke-related COVID-19. Good afternoon, George, and welcome to our podcast. Dr. George Ntaios:          Thank you for the invitation, Negar, and for highlighting our work. It's a pleasure to be here with you today. Dr. Negar Asdaghi:         Thank you for being here, and congrats on the paper. George, can you start us off by discussing the pathophysiological mechanisms through which COVID can potentially cause a stroke? Dr. George Ntaios:          Well, one of the most attractive things about stroke, which makes it fascinating for all of us, is its complexity. So many different pathologies can cause stroke, and, quite frequently, identifying the actual cause of stroke can be really challenging. And in a similar way, the pathophysiological association between COVID and stroke seems to be, again, complex. Different pathways have been proposed. Internal, we talk about two broad mechanisms. One is the vascular inflammation and thrombosis, and the other is cardioembolism. And there are several pathways which are involved in vascular inflammation and thrombosis: activation of the complement, activation of the inflammasome, activation of thrombin, increased production of [inaudible 00:24:47] constriction, state of stress, platelet aggregation, vascular thrombosis. So, collectively, this thromboinflammation could lead to damage of the neurovascular unit and consequently to stroke. And in a similar way, there are several cardiac pathologies which can cause stroke in a COVID patient, like acute left ventricular dysfunction, which can be caused, again, by several mechanisms, like coronary ischemia, stress-induced takotsubo cardiomyopathy, myocarditis inflammation, or also as a result of direct effect of the coronavirus at the myocardial cell. And, of course, we should not forget about atrial fibrillation, which seems to be more frequent in COVID patients. So, we see that the proposed mechanisms behind the association between COVID and stroke, that is, vascular thromboinflammation on one hand, or cardioembolism on the other hand, are complex, but whether these derangements they have a clinically relevant effect or they are just biochemical derangements without any clinical effect is a debate. For example, the incidence of myocarditis in COVID is about 0.2%. That is, in every 500 COVID patients, you have one patient with myocarditis. But myocarditis has a very wide clinical spectrum ranging from subclinical elevation of myocardial enzymes to full and life-threatening disease. So, obviously, the incidence of severe myocarditis is even lower than 0.2%. And the same is true also for the incidence of myocarditis after COVID vaccination. The CDC estimates that one case of myocarditis occurs every 200,000 vaccinations, with the number being slightly higher in young men after the second dose. And this is extremely rare, and the huge majority of these myocarditis cases, they're mild. So, this is about ischemic stroke. Now, with regard to hemorrhagic stroke and its association with COVID, again, it seems to be, again, very rare. The best estimate that we have comes from the Get With The Guidelines – Stroke Registry and is about 0.2% and involves mainly patients who are already on anticoagulants. So, they had already a risk factor for ICH. So, again, whether all these pathophysiologic derangements in COVID patients, they have a clinical meaningful association with stroke risk or not, I think it's a matter of debate. Dr. Negar Asdaghi:         Wow, George, it was a simple question, but it seems like the answer was not that straightforward. Let me just recap some of the things you mentioned. So, first of all, the answer is not straightforward and depends on whether we're talking about ischemic stroke or hemorrhagic stroke. There seems to be a lot of connecting points, at least, so to speak, between COVID and either forms of stroke. But you touched on two major sort of broad mechanisms. One is the idea of vascular thromboinflammation that goes along the lines of many sort of hyperacute, hyperinflammatory processes that can occur, especially in the setting of severe COVID. You touched on activation of thrombin, complement activation, platelet aggregation, sort of an activation of that microvascular or vascular unit in a sense. And then a second mechanism you touched on is the impact of COVID on the myocardium on sort of many different pathways. Again, you talked about acute left ventricular dysfunction, stress-induced myocarditis, and the impact of COVID on perhaps increasing the rate of atrial fibrillation. Again, these are all very complex associations, and some could be already present in a patient who is perhaps of an older age, and COVID is just a modifier of that risk factor that was already present in that particular person. And you also touched on how COVID can potentially increase the risk of hemorrhagic stroke, but the study seems to suggest that those patients already had risk factors for the same. And perhaps, again, COVID is a modifier of that risk factor. All right, so with that information, a number of studies early on, especially, in the pandemic and later, some meta-analyses, have aimed to estimate the incident rate of stroke post-COVID. Can you please briefly tell us what were their findings, and how is your current paper and current meta-analysis different in terms of methodology from those earlier studies? Dr. George Ntaios:          Yes. Well, it all started from this letter to the editor at the New England Journal of Medicine. It was published very early in the pandemic during the outbreak in New York. And in this letter, the authors had reported that within a period of two weeks, they had five young patients with COVID and large artery stroke, which they commented that it was much higher than their typical, actually their average, of 0.7 cases during a two-weeks period within the last year. And remember that back then, we knew literally nothing about COVID. So, this letter was really a huge, loud alert that something is going on here and that perhaps our hospitals would be flooded with COVID patients with stroke. So, subsequently, several reports were published aiming to estimate the incidence of stroke in COVID. Rather contradictory with the incidence, estimates are ranging from as low as 0.5% to even 5%. However, these estimates could well be inaccurate. They were observational studies. Most of them were limited to the inpatient setting. Most of them were single-center studies. Most of them, if not all, were retrospective studies. So, there was really a high risk of registration and assessment bias, as well as reporting bias. And also remember that back then during the outbreak, people were really reluctant to visit the hospital, even if they had a serious condition like stroke, an urgent condition, which means that the real incidences could be even higher. So, it was our feeling that these estimates were perhaps inaccurate. And there are also some meta-analyses of these studies which estimate that the incidence of stroke in COVID is about 1.5%. But, of course, any meta-analysis is as good as the studies it includes. So, we tried to find a way to have a more accurate estimate than these estimates. And we followed a different methodology. We studied randomized trials of COVID therapeutics, and we looked for strokes reported as adverse events or as outcome events. And the good thing about randomized trials is the rigorous assessment and reporting of outcomes in adverse events. So, we think, we believe, that this methodology provides a more reliable and a more robust estimate of stroke incidence in COVID patients. Dr. Negar Asdaghi:         OK. George, it's very important what you just mentioned, so I wanted to recap for our listeners some of the things you mentioned. It all started with a letter to the editor of New England Journal of Medicine on a report of five young patients that had large vessel occlusion in the setting of COVID. And then, basically, the floodgates opened in terms of all these observational studies that basically reported the same. And subsequent to that, meta-analyses that were completed containing those observational studies predominantly gave us an incident rate of 0.5 to 5%. That's much, much higher than basically the non-COVID–associated incidence rate of stroke in the population-based studies, and basically suggested that COVID-19 is indeed a major risk factor for all types of stroke. So, that's where it all started. And, as you alluded to, these numbers had to be reverified in bigger settings, more controlled setting. And you already answered my next question, which is the difference between those studies and prior meta-analyses to the current meta-analysis is that you basically took the simple question and started looking at it in a controlled setting of randomized trials. And you already answered this question of the methodology, but I want to recap. You took basically patients included in randomized trials of therapeutics for COVID-19, various therapies for COVID-19, and you did a meta-analysis to see what were the incident rate of stroke as an outcome in these trials. So, with that, could you please tell us a little more about the population that you had in this meta-analysis in terms of their age, the types of therapies that these randomized trials had looked at, and the duration of the follow-up, please? Dr. George Ntaios:          The follow-up included 77 randomized trials, which corresponds to more than 38,000 COVID patients. The mean age of these patients was about 55 years of age, and they were followed for an average of 23 days after study enrollment. With regard to the set strategy, I think it was not strict at all. I would rather say it was very liberal. We allowed trials of any drug in COVID patients of any age, of any severity, coming from any setting: outpatient, inpatient, either general ward or intensive care unit. And from any country. I don't think that we could achieve a wider inclusion than this strategy did. And the huge majority of patients, more than 95%, they were hospitalized patients. So, by definition, they had severe COVID disease. And the drugs studied in these trials included everything that was actually tried in COVID, including tocilizumab, IL-6R inhibitors, steroids, remdesivir, chloroquine, azithromycin, ritonavir, interferon, ivermectin, and many other drugs. So, I think we tried to include as many trials as possible. Dr. Negar Asdaghi:         OK. So, let me see if I got it. You basically included 77 randomized trials. It is a younger population of patients in these trials, median aged 55. You had a total of over 38,000 patients. It's a great sample size for this meta-analysis. And importantly, the duration of follow-up is median of 23 days. And it's just about any treatments we've heard that have been tried for COVID, from dexamethasone to remdesivir and ivermectin. And a rigorous methodology. So, I think we're ready to hear the primary results of this meta-analysis. How many strokes happened in these patients? Dr. George Ntaios:          In the overall population, that is both in the hospital and in the outpatient setting, there were totally 65 strokes in these 38,000 COVID patients, which corresponds to one stroke every 600 COVID patients or else an incident of only 0.16%, 0.16%. This is very low, much lower than the previous estimates. And, of note, all strokes occurred in hospitalized patients. There were no strokes at all in the ambulatory COVID patients. So, just to repeat the result, we just found that only one patient will have a stroke every 600 COVID patients who are either hospitalized or are ambulatory. Dr. Negar Asdaghi:         OK. So, I need to have these numbers, I think, committed to memory, especially when we speak to family members and patients in the hospital. Ninety-five percent of the patient population of this meta-analysis were inpatient COVID. So, by definition, they must be sicker in terms of the severity of their COVID disease. Out of 38,000 patients, you had 65 events of stroke. So, these are very, very important numbers, a lot basically lower than the incidence rate reported from prior studies. So, I wanted to ask you about the sensitivity analysis that was done in the meta-analysis. Dr. George Ntaios:          Yes. When we designed the analysis, we were expecting that we would find numbers was similar to those reported before. So, we thought that perhaps a sensitivity analysis would be able to increase the confidence and the robustness of the results. That's why we did this sensitivity analysis. However, it proved that the number of strokes, the number of outcome events was much lower than what expected. So, the power for those sensitivity analysis to show a meaningful conclusion was low. So, actually, that's why we don't comment at all on those sensitivity analysis because there were so few strokes to support such an analysis. Dr. Negar Asdaghi:         OK. So, basically, you had a priori design the meta-analysis based on the assumption that the incidence rate of stroke would be a lot higher, but then later on, when the incidence rates was lower, then the sensitivity analysis didn't really give any meaningful data to us. So, I mean, I think we already talked about this, but I want to ask you, why do you think that the incidence rates were so much lower in your analysis than the prior meta-analysis? Dr. George Ntaios:          I believe that our estimate is quite accurate. I think that the reports of stroke incidence published during the pandemic possibly overestimated the association. I think that the early concern that we all had in the beginning, that we would be flooded with strokes during the pandemic, was not confirmed. I think that we can support with decent confidence that stroke is a rare or perhaps very rare complication of COVID. Dr. Negar Asdaghi:         Right. That's great news. That really is great news, and we take every bit of good news in these trying times. George, something that was not touched on in the paper, but I want to ask you and basically get your opinion on this matter, is a much talked about concept in the COVID literature of how COVID could potentially modify certain risk factors. There are much talk about how people with pre-existing diabetes or obesity can potentially develop more severe COVID and, hence, have more complications of COVID, including stroke. What is your clinical experience on this matter, and do you think there are certain predictors of development of COVID-associated stroke? Dr. George Ntaios:          That's a very good point. For the last two years, I was involved in the hospitalization management of COVID patients. So, what we see is what is also described in the literature, that there are certain patient characteristics that predispose them to severe COVID. For example, obesity, for example, older age, pregnancy. Perhaps our analysis was not designed to respond to this question. The data available on the studies that were included, they could not support such an analysis. So, I cannot provide information from our study. But the fact that all strokes in our study, they occurred in hospitalized patients and none of them occurred in ambulatory patients, confirms what is known, that those strokes occurred in patients who, by definition, they have severe COVID disease. So, they confirm this putative association that perhaps severe COVID is associated with stroke rather than just mild COVID. Dr. Negar Asdaghi:         All right. Thank you. And I just want to end with this simple question that I get asked often, and I want to see how you respond to patients or their loved ones when you're asked this question: "Doctor, did COVID give me a stroke?" How should we answer that question? Dr. George Ntaios:          Yes. As we discussed, I think that stroke is a rather rare or perhaps very rare complication of stroke and certainly less frequent than we initially thought. And in those stroke patients who had already other pathologies which can cause stroke, I would be rather reluctant to attribute it to COVID. I would be perhaps more willing to do so in younger patients, but again, only after exhaustively looking for another cause, like PFO, dissection, etc. I mean, the concern is that if we as the treating stroke physicians assume that the stroke is caused by COVID, then we might discourage patients from doing the necessary diagnostic workup to find the actual cause of stroke. And if it happens, then perhaps an underlying pathology may be missed, which means that the patient will remain vulnerable to stroke recurrence. So, in general, I'm rather very reluctant to say that the stroke is caused by COVID unless a really thorough diagnostic workup shows nothing else at all. Dr. Negar Asdaghi:         All right. Very important message now to all practicing clinicians is don't stop at COVID. Don't just say simply, "Oh, this is COVID. COVID gave you a stroke." Keep looking for potential causes of stroke. Still do put that patient in the category of potentially ESUS or cryptogenic stroke if no other causes are found. And keep in mind that stroke is rare or, as George said, a very rare complication of COVID. Dr. George Ntaios, this is an exceedingly timely topic and a very important contribution to the field. Congratulations again on your paper, and thanks for taking the time to chatting with us today. Dr. George Ntaios:          Thank you for the wonderful discussion, Negar, and for the focus of our work. Dr. Negar Asdaghi:         Thank you. And this concludes our podcast for the November 2022 issue of Stroke. As always, please be sure to check out the table of contents for the full list of publications, as we can only cover a fraction of the incredible science published in this journal each month. And don't forget to check our fantastic Literature Synopsis. In this month's issue, we read a short summary of the ACST-2 trial published in Lancet on the results of a randomized comparison of stenting versus endarterectomy in asymptomatic carotid disease patients with over 60% of carotid stenosis. We also have the results of the CASSISS randomized trial, which was published in JAMA earlier this year, and it studied the effect of stenting plus maximal medical therapy versus maximum medical therapy alone on the risk of subsequent stroke and death in patients with symptomatic intracranial stenosis, either in the anterior or in the posterior circulation. CASSISS did not show that stenting was superior to maximum medical therapy, and sadly, these patients remain at a substantial risk of recurrent stroke despite being on best medical therapy. But I wouldn't be too despondent about the future of interventional therapy for intracranial atherosclerotic disease. After all, we've come a long way since Dr. Charles Thomas Stent, an English dentist, started experimenting with products to advance the field of denture making around 1865. The work that Dr. Stent had started would be continued by his two sons, both dentists, to eventually make its way to products to create surgical tools. But it would be another 100 years before the first percutaneous coronary procedure was completed in 1964. And in honor of Dr. Stent's pioneering work, the device used to keep the coronaries open was named, you guessed it, stents. Today's stroke care cannot be imagined without the use of various stents, and there's no doubt the future is promising for ways in which we will be able to safely treat intracranial atherosclerotic disease amongst all other vascular disorders. And what better way to keep our enthusiasm than staying alert with Stroke Alert. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.

Dr. Douglas Johnston is the Chief of Cardiac Surgery, Northwestern Medicine and Professor of Surgery, Northwestern University Feinberg School of Medicine. Prior to that he was Vice Chairman of the Department of Thoracic and Cardiovascular Surgery, Program Director of the Thoracic Surgery Residency and Advanced Cardiothoracic Fellowships, Surgical Director of the Aortic Valve Center, and staff cardiac surgeon in the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic. He completed his medical education at Harvard Medical School, where he was a Harvard National Scholar. Join us as we dive into the standardization of pathways and risk in healthcare, the importance of documentation and how innovation in healthcare drives patient outcomes.  

In Whom Should LVOT/Aortic Root Enlargement Be Performed at the Time of AVR Guest: Juan A. Crestanello, M.D. Host: Kyle W. Klarich, M.D. (@KyleWKlarich) Whom should an LVOT and/or Root Enlargement be performed at the time of an aortic value replacement? You will learn what a root enlargement is, why and how it is done, things to avoid, what to allow for in the future. You will hear what the risks of performing a root enlargement are and if it can be done in a redo surgery as well as its alternatives.  Joining us today to discuss In Whom Should LVOT/Aortic Root Enlargement Be Performed at the Time of AVR is Juan A. Crestanello, M.D., Professor of Surgery, Chair of the Department of Cardiovascular Surgery at Mayo Clinic in Rochester, Minnesota. Specific topics discussed: What is an aortic root enlargement? How is it done? Why do a root enlargement? Avoid patient prosthesis mismatch, allow for ViV in the future, prevent structural valve deterioration What is the risk of performing a root enlargement? Can you do a root enlargement in a redo surgery? What are the alternatives to a root enlargement? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Patient acuity is a critical benchmark for ensuring the patient has a proper care plan – it essentially saves lives. On MedAxiom HeartTalk, host Melanie Lawson talks with Amy Simone, PA-C, FACC, director of the Marcus Heart Valve Center at Piedmont Heart Institute, and Vinod Thourani, MD, FACC, professor of Cardiac Surgery and chief of Cardiovascular Surgery at Piedmont Healthcare at the Marcus Heart Valve Center. They discuss the challenges of accurately capturing patient acuity in heart failure patients and share innovative solutions to this problem. Guest BiosVinod Thourani, MD, FACC, Professor of Cardiac Surgery, Chief of Cardiovascular Surgery, Piedmont Healthcare at the Marcus Heart Valve Center - Dr. Thourani is board certified in surgery and cardiothoracic surgery. He earned his medical degree from Emory University School of Medicine. Dr. Thourani completed a general surgery internship at Emory University, followed by a residency and fellowship at Emory University. He also completed visiting fellowships for minimally invasive and transcatheter valve surgery at Fuwai Hospital in Beijing, China, and a fellowship with Prof Fred Mohr in Leipzig, Germany. Dr. Thourani is a member of the American Association for Thoracic Surgery, American Board of Thoracic Surgery, American College of Cardiology, American Heart Association, the Heart Valve Society, the International Society of Minimally Invasive Cardiothoracic Surgery, the South Atlantic Cardiovascular Society, and the Society of Thoracic Surgeons. He serves as the President of the Southern Thoracic Surgical Association (2019-2020) and the President-elect for the Heart Valve Society (2019-2020). Dr. Thourani specializes in valve surgery, specifically in minimally invasive and transcatheter aortic and mitral valve surgery. He is passionate about working with a multi-disciplinary team in providing the patient with options for traditional, minimally invasive, and transcatheter surgical options. In his spare time, Dr. Thourani enjoys spending time with his family, traveling, tennis, and going to sporting events and concerts. Amy Simone, PA-C, FACC, Director of the Marcus Heart Valve Center, Piedmont Heart Institute - Amy Simone is a Physician Assistant who received her training in Boston, MA at Massachusetts College of Pharmacy and Health Sciences. She is entering her seventeenth year of practice as a PA, and has spent over a decade in the Structural Heart arena. She served as the Structural Heart and Valve Coordinator at Emory University Midtown Hospital for over 6 years before transitioning to the Piedmont Heart Institute as the Director of the Marcus Heart Valve Center in 2017. She is a Past President of the Academy of Physician Associates in Cardiology (APAC) and in 2022 was appointed the APAC Structural Heart Disease Committee Chair. She is a Fellow of the American College of Cardiology (FACC) and serves on the ACC Cardiovascular Team Section Leadership Council, the ACC Physician Assistant Committee and the ACC Georgia Chapter Program Committee. In 2019 she co-published a textbook entitled Transcatheter Aortic Valve Replacement Program Development – A Guide for the Heart Team. She is passionate about patient advocacy and experience, program optimization, and addressing disparities in care. She lives in Atlanta, GA with her husband Michael and daughter Ivy.

Dr. Mara Antonoff, Associate Professor of Thoracic and Cardiovascular Surgery at MD Anderson Cancer Center, talks to FIA Board Member Jamila Piracci about her practical approach to inclusive recruitment that can be put into practice regardless of industry or sector. Speaking about recruitment themes very similar to those in the financial services industry, Dr. Antonoff explains how her recruitment process overcomes blind spots and implicit biases, resulting in an increased number of bright, accomplished and talented trainees from distinct backgrounds and experiences that better represent the diversity of patients they serve. “This is the start, but our work does not stop the moment someone gets their foot in the door,” Dr. Antonoff says, adding that “Conversations like this are important - we can learn from different fields, and we can share transferable experiences.”

Left Main Coronary Disease – Selecting the Best Treatment  Guests: Malcolm R. Bell, M.D. and Juan A. Crestanello, M.D. Host: Kyle W. Klarich, M.D. (@KyleWKlarich) In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between percutaneous coronary intervention and coronary-artery bypass grafting with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years. Joining us today to discuss the findings of the EXCEL Trail and how it has impacted clinical treatment is Juan A. Crestanello, M.D., a cardiovascular surgeon and Chair of the Department of Cardiovascular Surgery, and Malcolm R. Bell, M.D., an interventional cardiologist and Vice Chair of Cardiology at Mayo Clinic in Rochester, Minnesota.  Specific topics discussed: Patients studied in the EXCEL trial and major outcomes 5 year outcome of death, stroke, or myocardial infarction between coronary-artery bypass grafting or percutaneous coronary intervention Patient differences in coronary-artery bypass grafting versus percutaneous coronary intervention Impact the EXCEL trial has had in the clinical setting What types of patients are recommend for coronary-artery bypass grafting versus percutaneous coronary intervention Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

This week we move into the world of cardiac surgery when we review a recent work from Australia on levels of cefazolin during and after surgery. Is there an optimal dose regimen that will achieve proper MIC levels of drug? What should the goal of therapy be in regards to MIC levels? Are there novel means of dosing cefazolin? We speak with pediatric critical care pharmacy coordinator at Mount Sinai Kravis Children's Hospital, Dr. Jessica Frye for the pharmacist's perspective on some of these important questions. https://doi.org/10.1016/j.athoracsur.2022.02.047

Douglas Johnston, MD, is Vice Chairman, Program Director, and staff cardiac surgeon at the Cleveland Clinic. He attended Dartmouth College where he was a Presidential Scholar, earning his degree in Anthropology and Classical studies with Honor and Distinction. In the process he performed field research in tuberculosis among refugee communities in India. Dr. Johnston then went on to complete his medical education at Harvard Medical School, where he was a Harvard National Scholar.Dr. Johnston completed his clinical training in general surgery at the Massachusetts General Hospital in Boston. He was awarded the Edward D. Churchill Fellowship, the American College of Surgeons Resident Research Scholarship, and an NIH National Research Service Award for his research in the immunology of heart and lung transplantation.Dr. Johnston then completed his training in Thoracic and Cardiovascular Surgery at the Cleveland Clinic, including a focused fellowship in endovascular surgery and additional training in advanced 3-dimensional imaging techniques. He joined the cardiac surgery staff in 2008.Dr. Johnston is the author of numerous articles and abstracts published in leading scientific journals. His research interests include high risk aortic valve surgery and interventions, hybrid approaches to complex cardiac disease, and transcatheter interventions for valvular heart disease. He is a member of the American College of Surgeons, the International Society for Heart and Lung Transplantation, the International Society for Minimally Invasive Cardiac Surgery, and the Society of Cardiac Computed Tomography.An avid outdoorsman, Dr. Johnston enjoys hiking and sailing with his family during his time away from the hospital.Questions We Asked: Where in Cleveland do you hike and sail? Did you always know you wanted to be involved in leadership? What type of qualities do you look for in your team? Why doesn't everyone define leadership? What makes a good leader in the operating room? How do you develop calm in stressful situations? Where do you draw the line with emotional behavior in the OR?How do you recover from a leadership mistake? What advice would you give to yourself at the beginning of training looking back now? Favorite book and hike? Quotes & Ideas: “No matter what specialty you are in, you have teams of people working towards a common goal.” “The best leaders are those who develop other members of the team to be leaders” “Traditional residency training doesn't address this [leadership]” “A good leader will have the awareness to know the pulse of the room, but won't try to control everyone.” “When you achieve a state of flow, it's probably leadership that led to that.” “The best leaders I've seen are people whose energy level goes down in a crisis.” As a medical student, be the quiet professional Book Suggestions: Turn This Ship Around by L. David MarquetThe No Asshole Rule by Robert L Sutton 

Left ventricular assist devices (LVADs) can feel incredibly complex and these patients can inspire fear or trepidation in many healthcare providers. In this episode, we talk through the basics of LVADs from taking vital signs, to managing alarms, and evaluating common issues all with the experience and insights of our wonderful guest, Sarah Schettle, PA-C in Cardiovascular Surgery at Mayo Clinic. She is an incredible educator and breaks this topic down into really digestable and applicable pieces.   Check out a summary on the Mayo Clinic EM Blog

Commentary by Dr. Joon Bum Kim

Clinical research helps us find new treatments or evaluate what treatments are best for patients. Dr. Marc Gillinov, Chairman of Thoracic and Cardiovascular Surgery, describes types of research protocols used in heart surgery; patient safety; patient follow-up; and the purpose of research in clinical care.

Radiation heart disease is a difficult condition to treat. Radiation can cause damage to different parts of the heart. Dr. Douglas Johnston, Vice Chairman, Department of Thoracic and Cardiovascular Surgery discusses when to see a specialized cardiologist, what tests or procedures that may be needed, and what the next steps may be.

Dr Joe is a Homeopathic Practitioner, born in Brussels, then living in several different countries before deciding to settle in New Zealand. In this podcast, he shares how he went from working as a surgeon, to discovering natural medicine – and believe me, he has studied pretty much studied every single natural health modality there is. He has also published 11 books and lectured internationally. He'll also be speaking of the Fibonacci series, which has completely revolutionised the “potency problems” many Homeopaths experience. His CV is so unbelievably amazing, that I included it here for listeners to peruse.   Dr Joe's website is www.naturamedica.co.nz and emailed at homeosensei101@gmail.com    Curriculum Vitae. Doctor Joseph Rozencwajg, MD, PhD, NMD, HMD, DO, OMD, DAcup, DIHom, DHerbMed, DNutr, HbT, FBIH, RCHom, MNZIA, MNZAMH, MNNZ, MNZSN. Born in Brussels, Belgium, March 14, 1951 Medical School Université Libre de Bruxelles, Belgium, graduated 1976 Specialty in General Surgery: 2 years at Soroka Medical Center, Beersheva, Israel   4 years various hospitals in Belgium Belgian Specialist Surgeon 1982 Specialty in Thoracic and Cardiovascular Surgery, the University of Alberta, Edmonton, Canada Diploma in Acupuncture, ABMA (Belgian School of Acupuncture for MDs)   Member of the NZ Institute of Acupuncture     Member of the NZ Chinese Medicine and Acupuncture   Society (Registered Acupuncturist)   Member of the NZ Chi-Kung and TCM Association   Certificate from the China Academy of Chinese Medicine     Sciences (Acupuncture and TCM, MEDBOO course)   Oriental Medicine Doctor (OMD) Specialist in Homeopathy:   British Institute of Homeopathy, Diploma, Post Graduate   And Fellowship   Institut Homéopathique Scientifique, Paris   Israel Medical College of Homeopathy   Westbrook University, Aztec, New Mexico, USA   Diploma in Homotoxicology   PhD in Homeopathy, Westbrook University   RCHom New Zealand     Specialist in Phytotherapy (Herbal Medicine):   The School of Phytotherapy, UK  Member of the NZ Association of Medical Herbalists Diploma in Nutrition: the International Academy of Nutrition, Australia Diploma in Applied Clinical Nutrition (USA) Fellow of the American College of Applied Clinical Nutritionists Diploma in Homeobotanical Therapy, Australia Post-Graduate Diploma of Dynamic Phytotherapy  Doctor in Naturopathy (UNM/YINS) PhD in Natural Health Sciences (UNM/YINS) Doctor in Oriental Medicine (OMD, Calamus International University) Doctorate in Osteopathy (Drugless) (D.O.) Permanent student in Ortho-Bionomy Student in Cranio-Sacral Therapy Student in Visceral Manipulation Advanced Dorn Method Practitioner Miscellaneous: Auriculotherapy, Bach Flower Remedies, Aromatherapy,    Reflexology, Iridology, Reiki Master (Usui), MPRUE Great GrandMaster Practitioner and Instructor in Tai Chi and Qigong. Former Lecturer in Medical Diagnostics at the Faculty of Chiropractics and Homeopathy, Technikon Natal, Durban, South Africa. Former Lecturer in Homeopathy at the Israeli Medical College of Homeopathy. Former Tutor with the British Institute of Homeopathy (Homeopathy, Anatomy & Physiology, Pathology, Diagnostics and Nutrition) Professor of Natural Medicine at Calamus International University Publications: - Dynamic Gemmotherapy. Integrative Embryonic Phytotherapy. - Organotherapy, Drainage and Detoxification. - Removing the guesswork from potency selection: the Fibonacci Potencies series (paper). - The Fibonacci Series: update, discussion and conclusions (paper). - The Potency. Advanced prescribing in homeopathy: the Fibonacci Series. - Third Millennium Homeopathy - Homeopathy and Mental Health Care: Chapter 16 of this Anthology - Homeopathy through the Chinese looking glass: Homeosiniatry revisited - Elementary Nutrition for Homeopaths - Elementary Human Nutrition for Health Practitioners   Non-Medical qualifications: Diploma of Creative Writing from the NZ Institute of    Business Studies. Certificate in Mauri Ora (Maori studies) from Te Wananga O Aoteaora   First Dan Black Belt Aikido   Second Dan Black Belt Karate   Tai Chi Chuan and Qigong Practitioner   Yoga Student/Practitioner

In this episode, Dr. Gary  Sherman addresses many of the most important questions with Dr. Hayanga, in this most crucial time of the COVID-19 pandemic resurgence. Some of these questions are :- Why are the people seriously affected by the COVID-19 Variant younger than the previous population of affected patients? - What is ECMO and why does it play such a critical role in the therapy for those most seriously affected by the virus? - What are the factors that will allow the pandemic to subside so that we can feel a sense of "normalcy" again?- Why are some factions of people more drastically affected by the virus than others?- What is the most important "medicine" needed to mitigate the pandemic?- What is the role of Artificial Intelligence in helping to get a foothold on the COVID-19 pandemic resurgence? - How will the immunosuppressed portion of the population fare in the face of the pandemic and how will the pandemic affect organ donation? Dr. Hayanga is a Professor in Cardiothoracic Surgery at West Virginia University School of Medicine. He is the Director of the West Virginia University Heart & Vascular Institute ECMO Program. Dr. Hayanga is Board Certified in Cardiothoracic Surgery, General Surgery and Surgical Critical Care. He completed his general surgical training at Johns Hopkins University and the University of Michigan - followed by cardiothoracic and transplant training at the University of Washington and the University of Pittsburgh, respectively. Dr. Hayanga has served as an Alfred Sommer Scholar during his master's in public health training at the Johns Hopkins School of Public Health. He is also a 2008 World Health Organization (WHO) Patient Safety Scholar, a Department of Health and Human Services (HHS) Fellow and Senior Medical Advisor to the Deputy Secretary in Washington, D.C.  Dr. Hayanga holds a master's degree in Healthcare Leadership from Brown University and a certificate in Artificial Intelligence and Business Strategy from MIT.  He is an expert - Health - Policy panelist with RAND Corporation, elected member of American Association of Thoracic Surgery (AATS), and editorial board member for Journal of Thoracic and Cardiovascular Surgery, the Journal of Heart & Lung Transplantation, and LUNG.  He has authored over 150 peer-reviewed papers and his clinical work and research focus on ECMO, transplantation, and application of data analytics in the prevention, diagnosis, and mitigation of end-stage cardiopulmonary disease. He is a fellow of the American College of Surgeons, the Royal College of Surgeons, and the American College of Chest Physicians. DO NOT MISS this episode of great importance!! Dr. Hayanga sheds light on our most pressing questions during this uptick of variant-related illness throughout parts of our country. More about Dr. Jeremiah Hayanga's illustrious  background may be found at:  https://www.doximity.com/pub/jeremiah-hayanga-mde 

Now called the Pediatric Heart Transplant Society (PHTS), the Pediatric Heart Transplant Study Registry was established in 1993 by a group of physicians who wanted to improve the lives of children who needed a heart transplant. The Pediatric Heart Transplant Study (PHTS) was started by Dr. James Kirklin (cardiac surgeon), Dr. David Naftel (statistician), and Dr. Robert Morrow (pediatric cardiologist) at the University of Alabama at Birmingham in 1993. With more than 25 years of data collection, PHTS has produced over 120 abstract presentations and over 90 peer-reviewed manuscripts analyzing the continuum from pre-transplant risk factors to post-transplant morbidities which impact long-term survival after heart transplant in childhood. Dr. James K. Kirklin is a professor in the Division of Cardiothoracic Surgery and currently holds the James K. Kirklin Endowed Chair of Cardiovascular Surgery at the University of Alabama at Birmingham. He received the ISHLT Lifetime achievement award 2020 support, for his contribution in heart transplantation and mechanical circulatory support. Dr. Daphne Hsu, is one of the nation's leading experts in children's heart failure and heart transplant. She has been the past president and board member of the Pediatric Heart Transplant Study and she also reviews pediatric cardiology-related grants for the Food and Drug Administration and the National Institutes of Health.

On this week's episode of Fast Facts - Perio Edition your host, Katrina Sanders, RDH takes a look at prophylactic antibiotics for the reduction of potential infective endocarditis.   Quotes:    “As we've continued to see research unpacking some of the risks associated with utilizing antibiotics before a dental procedure, we've actually found that there are incredible risks associated with overuse of antibiotics in our patient population.”   “In fact, the guidelines note that people who are at risk for infective endocarditis are actually regularly exposed to oral bacteria during activities like brushing or flossing. And so the statement remains.”   “New research from the American Heart Association is encouraging optimal oral health as a key component to reducing the risk of infective endocarditis and may play a more profound role than the concerns of bacterial seeding and subsequent utilization of antibiotics prophylactically before dental procedures.”   Resources:   DentistRX: https://www.dentistrx.com  More Fast Facts: https://www.ataleoftwohygienists.com/fast-facts/    Katrina Sanders Website: https://www.katrinasanders.com  Katrina Sanders Instagram: https://www.instagram.com/thedentalwinegenist/    Sources:   Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116(15):1736-54. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc 2008;139 Suppl:3S-24S. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.  Circulation 2017; 135: e1159-e1195.  Accessed February 21, 2019. Wilson, W. R., Gewitz, M., Lockhart, P. B., Bolger, A. F., DeSimone, D. C., Kazi, D. S., ... & Baddour, L. M. (2021). Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation, CIR-0000000000000969.

Megan Jensen shares her experience as an APP within Cardiovascular Surgery.

In today's episode, you will meet Dr. Thomas E. MacGillivray, MD. She is a national top cardiothoracic surgeon currently working at Houston Methodist Hospital, the DeBakey Heart & Vascular center as the Chief of Cardiac Surgery and Thoracic Transplant Surgery, as well as the Jimmy Howell Endowed Chair in Cardiovascular Surgery. Previously, he was Co-Director of the Thoracic Aortic Center and Surgical Director of the Adult Congenital Heart Disease Program at Massachusetts General Hospital in Boston. Dr. MacGillivray currently serves as the Society's Treasurer-Elect; he previously was Chair of the Council on Education and Member Service for the Society of Thoracic Surgery.To connect with Dr. Thomas E. MacGillivray, MD find his link below:Website:  https://www.houstonmethodist.org/heart-vascular/Thank you again for joining us today! If you know anybody that would benefit from this episode please share it with them and help spread the knowledge and motivation. Don't forget to show your support for the Powerful and Passionate Healthcare Professionals Podcast by writing a review on iTunes. Your feedback helps the success of our show and pushes us to continuously be better!ADDITIONAL RESOURCES Want to save 8+ hours of work and reboot your focus within 2 minutes so you can do the things you love to do? Yes, it's really possible -- and I'm going to prove it to you! I offer 3 FREE consultations per week. Book yours here before they run out! SabrinaRunbeck.com/Blueprint Want to instantly restore your energy and brighten your fatigued eyes in 2 minutes? Download your FREE audio exercises and discover them for yourself. This is just the tip of the iceberg, and I know you have a lot more questions that you want to get answered. Join us inside our private community for our weekly Ask Me Anything sessions and monthly networking with like-minded healthcare practitioners.  

In this episode, Dr. John Chuback and I discuss the subconscious programming we all have running our lives, and how to change the system. John A. Chuback, M.D., is Board Certified in General Surgery and Cardiovascular Surgery. He received his MD from Rutgers University and has been in private practice in Paramus, New Jersey, for 16 years. Dr. Chuback is also a successful entrepreneur: he is the founder and Chief Medical Officer at Chuback Medical Group, founder and managing member of Elant Hill, LLC, and the nutraceutical company BiosupportMD. He is the recipient of the Patient's Choice Award and Compassionate Doctor Recognition amongst many other honors. Dr. Chuback founded Chuback Education, LLC, which offers audio programs on subjects like weight management, smoking cessation, personal development, and academic achievement, and he is the author of Make Your Own Damn Cheese: Understanding, Navigating, and Mastering the 3 Mazes of Success and Kaboing! 50 Ideas That Will Springboard You To Academic Greatness. In this episode, we discuss: ·      His medical background and what caused him to enter the world of personal and spiritual development. ·      The difference between your strengths, your passions, and your interests. ·      A synopsis of the book Who Moved My Cheese and why it profoundly impacted his life. ·      How easily we can end up in a life that doesn't feel right or fulfilling and why it happens. ·      The difference between real thinking vs. mental activity that we view as thinking. ·      The objective and subjective parts of our mind, when they are developed, and how they interact. ·      The relationship between the body, the brain, the mind, and you. ·      How to recognize the programming in our minds that isn't working for us and what to do about it. ·      How to shift your mindset from blaming others to taking personal accountability. ·      And finally, what exactly we need to do to reprogram our minds, or like the title of his book – make our own damn cheese. You can find and follow Dr. Chuback here: ChubackEducation.com Instagram: @JohnChubackMD Facebook: @ChubackEducation Twitter: @ChubackED His book – Make Your Own Damn Cheese: Understanding, Navigating, and Mastering the 3 Mazes of Success RESOURCES: Who Moved My Cheese?: An Amazing Way to Deal with Change in Your Work and in Your Life by Spencer Johnson Eckhart Tolle Jim Rohn Bob Proctor Denis Waitley Brian Tracy Price Pritchett Man's Search for Meaning by Viktor Frankl Earl Nightingale SHOP CLEAN products with DISCOUNTS in my SHOP! Please SUBSCRIBE, SHARE, RATE, and REVIEW the podcast! Follow the podcast on Instagram @TheBetterYouPodcast or Facebook @TheBetterYouPodcast. And you can email the podcast at TheBetterYouPodcast@gmail.com Follow me on all the socials: Instagram @kaciemain_writes, Facebook @kaciemain.write, or Twitter @kaciemain_write. Find my book – I Gave Up Men for Lent, the story of a jaded, hopelessly romantic, health-conscious party girl's search for meaning – on Amazon, Kindle, and Audible. And for everything else you want to know about me, visit my website at www.kaciemain.com     Some links are Affiliate links.

Connecticut Children's cardiologist Seth Lapuk, MD, joins host Patricia Garcia, MD, to discuss heart murmurs. The two physicians are joined by Hannah, a patient, and her family to discuss their experience at with the Division of Cardiology and Cardiovascular Surgery.