POPULARITY
5 episodes with mechanical circulatory support
8 episodes with mechanical circulatory support
5 episodes with mechanical circulatory support
3 episodes with mechanical circulatory support
2 episodes with mechanical circulatory support
2 episodes with mechanical circulatory support
3 episodes with mechanical circulatory support
2 episodes with mechanical circulatory support
2 episodes with mechanical circulatory support
On this special episode of JHLT: The Podcast, the Digital Media Editors take a look back at the exciting science that was on display at ISHLT2025, the ISHLT 45th Annual Meeting & Scientific Sessions. Topics include: Telomere biology disorders and lung transplantation The meeting's special focus on cardiogenic shock The apixiVAD trial exploring low dose apixaban in HeartMate 3 LVADs Myocardial recovery on durable LVADs For the latest studies from JHLT, visit jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at ishlt.org/jhlt. Full-text abstracts of the meeting can also be found at the JHLT website. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
With Justyna Sokolska, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw - Poland, and Maja Cikes, University of Zagreb School of Medicine, Head at the Unit for Heart Failure and Mechanical Circulatory Support, Department of Cardiovascular Diseases, University Hospital Center, Zagreb - Croatia. In this episode of HFA CardioTalk, Justyna Sokolska interviews Maja Cikes on the challenges in management of long-term left ventricular assist device in patients with advanced heart failure. The discussion emphasizes the importance of selecting appropriate patients at the optimal time, examines the adverse events and highlights major ongoing clinical trials. Recommended readings: Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial, Mehra MR, et al. JAMA. 2023 Dec 12;330(22):2171-81 Trends and Outcomes of Left Ventricular Assist Device Therapy: JACC Focus Seminar, Varshney AS, et al. J Am Coll Cardiol 2022 Mar 22;79(11):1092-1107 Cardiac implantable electronic devices with a defibrillator component and all-cause mortality in left ventricular assist device carriers: results from the PCHF-VAD registry, Cikes M, et al. Eur J Heart Fail 2019 Sep;21(9):1129-41 A Fully Magnetically Levitated Left Ventricular Assist Device — Final Report, Mehra MR, et al. N Engl J Med 2019 Apr 25;380(17):1618-27 This 2025 HFA Cardio Talk podcast series is supported by Bayer AG in the form of an unrestricted financial support. The discussion has not been influenced in any way by its sponsor.
Returning for a second study this month, the JHLT Digital Media Editors invite first author Charlotte Van Edom to discuss the paper, “Apixaban plasma levels in patients with HeartMate 3 support.” As a cardiologist in training and a PhD candidate at the University Hospitals Leuven in Belgium, Van Edom's work focuses on hemocompatibility and mechanical circulatory support, covering both short-term and long-term support. The episode explores: The evolution of the use and understanding of direct oral anticoagulants (DOACs) during LVAD support, including the increased focus on Factor Xa inhibitors Encouraging findings from the study and what clinical practices might need to change if introducing apixaban Additional studies exploring DOACs in LVAD patients For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. Treat or research pulmonary vascular diseases? Check out the first April episode for a study on sotatercept in PAH patients. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
Happy new year from JHLT: The Podcast! On this episode, the Digital Media Editors are joined by ISHLT Director of Marketing + Communications Jess Burke, CAE, to share a little bit about themselves and their backgrounds. Hear about how each of the JHLT Digital Media Editors got involved in transplantation and a little about each of their research and personal interests. For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. Don't already get the Journal? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
Mirza Umair Khalid, MD, social media editor of JACC: Cardiovascular Interventions; Ehud Schwammenthal, MD, PhD; and Duane S. Pinto, MD, MPH, discuss the first in-human study of the Magenta Elevate device for use in high-risk PCI.
On the second November episode of JHLT: The Podcast, the Digital Media Editors continue MCS-month with a paper from the November issue of JHLT, entitled “Aortic insufficiency in the patient on contemporary durable left ventricular assist device support: A state-of-the-art review on perioperative and postoperative assessment and management.” First author Diyar Saeed, MD, PhD, of the Heart Center Niderrhein, and senior author Jennifer Cowger, MD, MS, of Henry Ford Hospitals both join the podcast. You'll hear about: Why LVAD patients develop new and progressive aortic regurgitation—and how contemporary devices may differ Associated hemodynamic events Intraoperative surgical techniques Slowing the progression of the condition and monitoring it post-op Early interventions For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. If you haven't yet tuned in for the first November episode of the podcast, MCS enthusiasts will be happy to know the paper discusses temporary MCS devices in acute RV failure. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
On this episode of JHLT: The Podcast, the Digital Media Editors have three expert guests to discuss their paper, “Pragmatic approach to temporary mechanical circulatory support in acute right ventricular failure.” You'll hear from first author Anthony Carnicelli, MD, from the Medical University of South Carolina; Alexander Bernhardt, MD, from the University Hospital Hamburg-Eppendorf; and senior author Manreet Kanwar, MD, of the Cardiovascular Institute at Allegheny Health Network. The episode explores: Parameters that influence deciding when to escalate RV support Determining which device is right for each patient Evaluating a patient for the correct anticoagulants Device-related complications and solutions What's next in research for tMCS and acute RV failure For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. Join us again later this month for another MCS study, exploring aortic insufficiency in patients with durable LVADs. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
On this episode of JHLT: The Podcast, the Digital Media Editors discuss a new guidelines document from the ISHLT entitled “The 2024 ISHLT Guidelines for the Evaluation and Care of Cardiac Transplant Candidates.” The lead co-authors of the document—Yael Peled, MD, and Anique Ducharme, MD, MSc—are on the podcast to discuss the document. You'll hear about: Challenges in drafting such an overarching document Highlights for clinicians Major changes in the document since the last version How changes in durable and temporary MCS affect use of the document For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. Join us again later this month for a study on age matching in lung transplantation. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
On this episode of JHLT: The Podcast, the JHLT Digital Media Editors discuss a brand new consensus document from the ISHLT entitled “Strategies to Prevent Hemocompatibility Related Adverse Events in Patients with a Durable, Continuous-Flow Ventricular Assist Device.” The episode is hosted by Digital Media Editor Erika Lease, MD, FCCP, a transplant pulmonologist from the University of Washington. The consensus document's lead author, Ian Hollis, PharmD, a heart failure pharmacist and Associate Professor from the University of North Carolina in Chapel Hill, joins the podcast to discuss the document. During the discussion, he's reunited with co-author and JHLT Podcast co-host Van-Khue Ton, MD, for a lively discussion of the document's findings and takeaways. If you work with heart failure patients with durable VADs, you'll want to listen to this episode—and check out the complete document at ISHLT. Stay tuned for a second episode later this month, where we'll be talking about a modular simulation framework for organ allocation.
Magenta Elevate™: High-Output, Low French Size Percutaneous Mechanical Circulatory Support
This is the second part in our series discussing temporary mechanical circulatory support (tMCS). Part one, covered different types of devices for tMCS, pathophysiology of shock, clinical indications, and general considerations for critical care clinicians. In Part 2, Dr. Zanotti covers a more detailed discussion of medical management and troubleshooting of patients on tMCS. He is again joined by Bindu Akkanti, MD, an associate professor in the Division of Pulmonary, Critical Care, and Sleep Medicine at UTHealth Houston. Dr. Akkanti is the Medical Director of the Heart Failure ICU and the Director of Critical Care for the Heart & Vascular Institute at Memorial Hermann Texas Medical Center. Additional Resources: More about Dr. Akkanti: https://med.uth.edu/internalmedicine/2022/11/17/bindu-akkanti-md/ Mechanical Circulatory Support Part 1 - Critical Matters Podcast. https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1828006629 A Comprehensive Review of Mechanical Circulatory Support Devices. V Atti, et al. Heart Intl. 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524665/ American Society of Artificial Internal Organs website. https://asaio.org/ IABP: Hemodynamics, troubleshooting, technical tips. https://www.youtube.com/watch?v=ULgjuhBgP9U Composer and Musician A.R. Rahman. https://www.arrahman.com/
Cardiogenic shock accounts for up to 5% of acute heart failure presentations and around 14–16% of patients reported in cardiac intensive care datasets. It complicates up to 15% of all myocardial infarctions and is the leading cause of death post-infarction. Using pharmacological agents alone may increase left ventricular afterload and myocardial oxygen demand, resulting in complications. Thus, mechanical circulatory support (MCS) devices have emerged as important therapeutic options. As evidence remains uncertain, MCS selection depends on clinician preference and local availability.An updated systematic review and meta-analysis of high-quality RCTs and propensity score-matched studies (PSMs) was performed to compare the outcomes of MCS devices with no MCS and each other and investigate which MCS is the most effective in reducing mortality.To learn more about the findings of this study listen to this podcast.
On this episode of JHLT: The Podcast, the JHLT Digital Media Editors explore two studies from the June issue of The Journal of Heart and Lung Transplantation. Digital Media Editor Van-Khue Ton, MD, a transplant cardiologist from Massachusetts General Hospital, hosts this episode. First, Dr. Ton and Digital Media Editor Marty Tam, MD, interview their first guests, first author Matthew Carey, MD, MBA, and senior author Justin Fried, MD, both of the Columbia University Irving Medical Center in New York City, on their study “Aortic Root Thrombosis in patients with HeartMate 3 left ventricular assist device support.” This retrospective study of all patients receiving a HeartMate 3 LVAD at a single center between November 2014 and August 2020. The study evaluated findings related to patients with aortic root thrombosis, classified as having at least 1 echocardiogram or contrast-enhanced CT scan with thrombus. In the population of 197 patients, 19 had aortic root thrombus, which was ultimately associated with an increased risk of developing significant aortic regurgitation during the study period. Drs. Carey and Fried discuss whether aortic valve opening is associated with increased risk of aortic root thrombus, how to balance the bleeding-thrombosis scale in patients, and how the study fits in the context of prior generations of LVAD. Next, Dr. Ton joins and Digital Media Editor Erika Lease, MD, FCCP, to interview, Jacqueline DesJardin, MD, a Fellow in the department of medicine at the University of California San Francisco. Dr. DesJardin is first author on the study “Investigating the “sex paradox” in pulmonary arterial hypertension: Results from the Pulmonary Hypertension Association Registry (PHAR).” PHAR is a multicenter US-based registry of patients with PAH, and this study analyzed 1,891 patients from the registry, 1,425 (75%) of whom were female. At baseline, compared to men, women had worse functional status and worse hemodynamics. Women were more likely to be on triple therapy or parenteral prostacyclin therapies at baseline. Interestingly, women had better survival than men, even after adjusting for numerous variables. In the discussion, Dr. DesJardin explains what collider stratification bias is, and how it may illuminate the complex epidemiological system that creates this disparity. She shares the three potential causal models posed in the study, and considers how the study might be followed up. Follow along at www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
In the first part of this two-part series, Dr. Zanotti is joined by Bindu Akkanti, MD, an associate professor in the Division of Pulmonary, Critical Care, and Sleep Medicine at UTHealth Houston. Together, they discuss temporary mechanical circulatory support, an increasingly vital modality in treating cardiogenic shock and other subsets of critically ill patients in shock. Dr. Akkanti is the Medical Director of the Heart Failure ICU and the Director of Critical Care for the Heart & Vascular Institute at Memorial Hermann Texas Medical Center. Additional Resources: More about Dr. Bindu Akkanti: https://med.uth.edu/internalmedicine/2022/11/17/bindu-akkanti-md/ Review of Pathophysiology of Cardiogenic Shock and Escalation of Mechanical Circulatory Support Devices. Pahuja M, et al. Curr Cardiol Rep 2023: https://pubmed.ncbi.nlm.nih.gov/36847990/ Temporary mechanical circulatory support devices: practical considerations for all stakeholders. Salter BS, et al. Nature Reviews Cardiology 2023: https://www.nature.com/articles/s41569-022-00796-5 Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. Moller JE, et al. N Engl J Med 2024: https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 Books Mentioned in this Episode: The Alchemist. By Paulo Coelho: https://bit.ly/3yv4Zmt
Drs Michelle Kittleson and Jennifer Cowger discuss navigating the future of heart failure care through durable mechanical circulatory support, including patient selection, outcomes, and upcoming advances. Relevant disclosures can be found with the episode show notes on Medscape https://www.medscape.com/viewarticle/997321. The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Heart Failure https://emedicine.medscape.com/article/163062-overview The Future of Durable Mechanical Circulatory Support: Emerging Technological Innovations and Considerations to Enable Evolution of the Field https://pubmed.ncbi.nlm.nih.gov/38431185/ Impact of 2018 Allocation System Change on Outcomes in Patients With Durable Left Ventricular Assist Device as Bridge to Transplantation: A UNOS Registry Analysis https://pubmed.ncbi.nlm.nih.gov/36973093/ OPTN Policy 6: Allocation of Hearts and Heart-Lungs https://unos.org/resources/heart-lung-toolkits/ The Impella Device: Historical Background, Clinical Applications and Future Directions https://pubmed.ncbi.nlm.nih.gov/31384109/#full-view-affiliation-1 INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profiling Identifies Ambulatory Patients at High Risk on Medical Therapy After Hospitalizations for Heart Failure https://pubmed.ncbi.nlm.nih.gov/27834198/ Response Shift in Patient-Reported Outcomes: Definition, Theory, and a Revised Model https://pubmed.ncbi.nlm.nih.gov/33909187/ Physiology and Clinical Utility of HeartMate Pump Parameters https://pubmed.ncbi.nlm.nih.gov/34980564/ 2023 Gordon Research Seminar on Assisted Circulation (GRS): Translating Mechanical Circulatory Support from Bench to Bedside to Global Implementation https://www.grc.org/assisted-circulation-grs-conference/2023/
Complete your knowledge around mechanical circulatory support (MCS) devices with this episode on Temporary MCS with Dr. Pankaj Jain from Sydney. This episode touches on cardiogenic shock before exploring the ins and outs of temporary MCS devices including the balloon pump, the impella devices and VA ECMO. DanGer Shock - a large RCT evaluating the Impella device - was released during the recording of this podcast so be sure to stick around for the discussion of DanGer Shock at the end of the podcast.As always, happy listening! If you have any suggestions or would like to join me on the show please reach out to me at rahul@mattersoftheheartcast.com
In this week's episode of Parallax, Dr Ankur Kalra welcomes Dr Shashank Sinha. Dr Sinha is an Advanced Heart Failure, Mechanical Circulatory Support, and Transplant Cardiologist at Inova Fairfax Medical Campus, where he serves as Co-Medical Director of the Cardiac Intensive Care Unit and Director of the Cardiovascular Critical Care Research Program. Additionally, he holds the position of Assistant Professor of Medical Education at the University of Virginia School of Medicine. In this episode, Dr Sinha shares his insights on leadership after participating in the prestigious Presidential Leadership Scholars Programme. This programme, designed for mid-career professionals with 10+ years of experience, aims to foster bipartisan, action-oriented leaders. Dr Sinha discusses what motivated him to apply for the programme and guides us through the practical details of the process. Ankur asks him about his modules and the lessons he derived from this multidisciplinary programme. Dr Sinha and Dr Kalra discuss civic duty and the values that can be nurtured to make a difference on a larger scale. Dr Kalra also asks about Dr Sinha's approach to conflict management and combating inherent bias. What is the Presidential Leadership Programme? What qualities constitute a good leader? How can individuals foster their leadership skills?
Join Rahul and Dr. Sriram Rao as they plumb through the depths of mechanical circulatory support for advanced heart failure. Dr. Rao is the Director of Heart Failure at the Victorian Heart Hospital. He has a wealth of experience in ventricular assist devices and heart transplant, having just returned from the Hospital for the University of Pennsylvania and MedStar Washington Hospital in the USA. We cover the state of the art in ventricular assist devices and total artificial hearts, as well as the key points for a non-VAD cardiologist to be across.
This presentation was delivered by Panka Jain as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022. For more information about the CODA Project go to: https://codachange.org/
Welcome to 2024! The JHLT Digital Media Editors kick off the new year with a look back at the best of the best from 2023 – specifically, a few of the guidelines and consensus statements from the International Society for Heart and Lung Transplantation that appeared in The Journal of Heart and Lung Transplantation this past year. Digital Media Editor David Schibilsky, MD, a cardiothoracic surgeon from Freiburg, Germany, hosts this episode. First, Digital Media Editor Marty Tam, MD, reviews the updated Heart Transplantation guidelines, published in JHLT at the start of 2023. What's changed in the decade plus since the 2010 guidelines were published? For starters, there's more than 200 new or updated recommendations in this document, and Dr. Tam walks you through some of the highlights. Next, Digital Media Editor Erika Lease, MD, shares the new reproductive health guidelines for transplant patients—something that's relevant to just about everyone working in the cardiothoracic transplantation space. Dr. Lease steps through this much-needed consensus statement and some of its key takeaways. Finally, Dr. Schibilsky joins his fellow Digital Media Editor Van-Khue Ton, MD, for a discussion about the MCS guidelines, another 10 year update on a massive—and massively important—document. Drs. Schibilsky and Ton share their favorite parts of the guideline, and do a little imagining about what might be present in the next major update for MCS. Follow along at www.jhltonline.org/current, or check out all of the ISHLT's Standards and Guidelines documents at https://ishlt.org/publications-resources/professional-resources/standards-guidelines. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
Host Sarah Lorenzini and Christian Guzman APRN are back to conclude this three-part heart failure series by examining the use of mechanical circulatory support for cardiogenic shock. This episode expands on the topics covered in previous parts, focusing on the application of mechanical circulatory support methods like the intra-aortic balloon pump, Impella, CentriMag, LVADs, and ECMO.Christian and Sarah review the risks and benefits of each device, when to use them, and the key factors that impact these decisions. They also address the ethical challenges of ECMO, including the clinical judgment involved when determining who's a good candidate and when to escalate care.By the end of this episode, you'll understand how these devices function, their critical role in managing cardiogenic shock in heart failure patients, and the value nurses bring to a multidisciplinary team.Tune in for a knowledge-packed finale of this comprehensive heart failure series!Topics discussed in this episode:The role of mechanical circulatory support devicesBenefits and risks of the intra-aortic balloon pump and Impella deviceHow to properly use Impella devicesCentriMag and Left Ventricular Assist Devices (LVADs)The evolution of permanent LVADsExtracorporeal Membrane Oxygenation (ECMO) for cardiac supportChallenges and ethical considerations of ECMOThe importance of nursing knowledge and confidenceConnect with Christian Guzman APRN on Instagram:https://www.instagram.com/thenerdynursepractitioner/Watch this episode on The Rapid Response RN YouTube Channel! https://www.youtube.com/@therapidresponsern/videosMentioned in this episode:Coming Soon! Rapid Response Academy: The Heart and Science of Caring for the SickClick here to learn more about the community that Sarah is building: https://www.rapidresponseandrescue.com/coming-soon-rapid-response-academy Rapid Response and Rescue Intro CourseCONNECT
Behind the Drapes: Anesthesiology and Critical Care Medicine
In this episode, I bring you inside what our shock/MCS course looked like this week in conjunction with the Cardiology department. Mechanical Circulatory Support is an evolving field in medicine, especially in the critically ill population. Meaning managing patients with these devices will be a huge part of my future career. Listen along to hear some of my biggest take aways from the day!
The JHLT Digital Media Editors explore two manuscripts from the October issue of The Journal of Heart and Lung Transplantation—the first on lung transplantation in patients with stacked risks, and the second on bacterial pathogens found at driveline exit sites in patients with ventricular assist devices. Digital Media Editor Marty Tam, MD, assistant professor in the division of cardiovascular medicine at the University of Michigan, hosts this episode. First, hear from senior author Edward Cantu, MD, MSCE, on his team's study “Transplanting candidates with stacked risks negatively affects outcomes.” Lung transplant centers are increasingly evaluating patients with multiple risk factors for adverse post-transplant outcomes, yet there is little data of the effects of these risks as they stack. The authors of the study used the UNOS registry data linked to the National Inpatient Sample (NIS) to create a national encounter-level sample of healthcare data in the United States, then applied a probabilistic matching algorithm using 7 variables and determined associations between mortality, length of stay, total charges, and disposition with the number of comorbidities. For details on what the study found about how these risks affected patient success—based on factors like mortality, length of stay, duration of mechanical ventilation, need for ECMO-salvage, total charges, and discharge to a skilled nursing facility—listen to the discussion in the episode. Next, the editors explored the study “Dynamics of bacterial pathogens at the driveline exit site in patients with ventricular assist devices: A prospective, observational, single-center cohort study.” While the authors weren't able to join the episode, editors corresponded with senior author Monika Fürholz, MD, from the Bern University Hospital in Switzerland, before recording, and shared some of her insights. Driveline exit site infections commonly occur in patients with LVADs, and can be a source of recurrent or deeper infections. Bacterial colonization of driveline exit sites has not been well studied, and transition from colonization to infection is also not well understood. The authors of this paper sought to address this by conducting a prospective, observational, single-center cohort study which included systematic and routine collection of driveline exit site skin swabs being taken between June 2019 and December 2021, even in the absence of suspected driveline infection. Bacteria were identified and a subset of the samples underwent whole-genome sequencing. For details on what the study found, including a discussion of how the study findings might impact current practice, check out the episode. Follow along at www.jhltonline.org/current, or, if you're an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
Commentary by Dr. Valentin Fuster
It will be a special Mother's Day for a woman with 13 grandchildren who underwent a heart transplant. Guests include Dr. Matt Danter, Surgical Director of Cardiac Transplant and Mechanical Circulatory Support.
CardioNerds (Dr. Amit Goyal), Dr. Sonu Abraham (CardioNerds Ambassador from Lahey Hospital and Medical Center, Burlington, MA) discuss left ventricular assist devices (LVAD) and the implications of renal dysfunction with Dr. Brian Houston and Dr. Nisha Bansal. This episode will focus on the intersection of left ventricular assist devices and renal dysfunction. Patients with a combination of heart failure and renal dysfunction overall have a guarded prognosis and their management poses unique challenges to the clinician. We initially discuss the basics of an LVAD and general approach to LVAD candidacy evaluation. We then discuss specific implications of acute kidney injury, presence of preexisting CKD, and end stage renal disease in patients with/being considered for an LVAD. Risk factor identification and prognostication allows for appropriate selection of the right candidates for an LVAD in the context of renal disease. Dr. Brian Houston is the Director of the Mechanical Circulatory Support program at Medical University of South Carolina. Dr. Nisha Bansal is an Associate Professor and the Arthur Stach Family Endowed Professor in the Division of Nephrology, an investigator at the Kidney Research Institute, the Director of Nephrology Clinical and Research Education, and the Director of the Kidney-Heart Service at the University of Washington. Notes were drafted by Dr. Sonu Abraham and episode audio was edited by student Dr. Chelsea Amo-Tweneboah. Check out the CardioNerds Failure Heart Success Series Page for more heart success episodes and content! CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Left Ventricular Assist Devices and Renal Dysfunction End stage renal disease (CKD on dialysis) is considered an absolute contraindication for LVAD implantation. Select young patients who are being considered for heart-kidney transplantation in the near future may be candidates for an LVAD as a bridge to heart-kidney transplantation. LVAD implantation can improve kidney function in the short term in patients with AKI primarily caused by cardio-renal syndrome. Patients with pre-existing CKD (not dialysis dependent) have a greater risk of developing AKI after LVAD implantation. Several dialysis modalities including in-center hemodialysis, home hemodialysis, and peritoneal dialysis are available for LVAD patients. However, there are several challenges associated with each modality. An AV graft is a useful vascular access option in LVAD patients undergoing hemodialysis due to a lower risk of infection and ease of immediate use. Causes for anemia in patients with an LVAD and renal dysfunction include anemia of chronic disease, gastrointestinal bleeding, and pump thrombosis leading to hemolysis. Show notes - Left Ventricular Assist Devices and Renal Dysfunction Notes: (drafted by Dr. Sonu Abraham) What is a left ventricular assist device (LVAD) and what are its components? An LVAD supports circulation by unloading the left ventricle and providing increased cardiac output to help support organ perfusion. Use in properly selected patients is associated with improved quality of life and increased survival. The current iteration of LVADs offer continuous flow, as opposed to the older versions which employed pulsatile flow. Components of the LVAD: Inflow cannula (sucks blood from the LV) Pump Outflow cannula (dumps blood into the aorta) Percutaneous driveline Electrical controller How is a patient evaluated for LVAD candidacy? The 2 main questions to be answered during the evaluation of a patient for an LVAD are: 1. Are they sick enough? Do they have end stage heart failure? 2. Do we expect the benefits of an LVAD to outweigh the risks? ...
It's another session of CardioNerds Rounds! In these rounds, Dr. Karan Desai (Formerly FIT at University of Maryland Medical Center and currently faculty at Johns Hopkins School of Medicine) joins Dr. Dan Burkhoff (Director of Heart Failure, Hemodynamics and MCS Research at the Cardiovascular Research Foundation) to discuss mechanical circulatory support options through the lens of pressure-volume loops! Dr. Burkhoff is the author of Harvi, an interactive simulation-based application for teaching and researching many aspects of ventricular hemodynamics. Don't miss this wonderfully nerdy episode with a world-renowned expert in hemodynamics and MCS! Audio editing by CardioNerds Academy Intern, student doctor Chelsea Amo Tweneboah. This episode is supported with unrestricted funding from Zoll LifeVest. A special thank you to Mitzy Applegate and Ivan Chevere for their production skills that help make CardioNerds Rounds such an amazing success. All CardioNerds content is planned, produced, and reviewed solely by CardioNerds. Case details are altered to protect patient health information. CardioNerds Rounds is co-chaired by Dr. Karan Desai and Dr. Natalie Stokes. Challenging Cases - Atrial Fibrillation with Dr. Hugh Calkins CardioNerds Rounds PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Show notes - Hemodynamics and Mechanical Circulatory Support Case Synopsis: Case SynopsisWe focused on one case during these rounds. A man in his mid-50s presented to his local community hospital with 3 days of chest pain, nausea, and vomiting. He appeared ill in the emergency room with HR in the 150s, BP 90/70s and ECG demonstrating inferior ST elevations. He was taken emergently to the catheterization lab and received overlapping stents to his right coronary artery. Over the next 24 hours, he developed a new harsh systolic murmur heard throughout his precordium and progressed to cardiogenic shock. Echocardiogram demonstrated a large basal inferoseptum ventricular septal rupture. From this point, we discussed the hemodynamics of VSR and MCS options. Case Takeaways Dr. Burkhoff took us through the hemodynamics of VSR with pressure-volume loops to better understand the pathology and impact of various MCS options. Of note, there are no MCS devices specifically approved to treat acute ventricular septal rupture. In regards to the acute hemodynamic effects of a VSR (an abrupt left to right shunt), there are several aspects to note. First, the effective LV afterload is reduced; however, there is less “forward flow” as well and as a consequence, decreased left-sided cardiac output (“Qs”) and blood pressure. At the same time, flow through the pulmonary artery increases (the “Qp”). Additionally, due to the abrupt shunt flow, there is increased RV “loading” with increasing central venous pressure and pulmonary artery pressure. The hemodynamic priorities in treating patients with cardiogenic shock and VSR are to normalize blood pressure, cardiac output, and oxygen delivery, while attempting to minimize shunt flow to allow healing. However, medications and MCS are unlikely to completely normalize hemodynamics. For instance, if the patient was placed on peripheral VA ECMO, while total CO and BP may increase, flow across the VSR could also increase at high ECMO flows (e.g., by introducing more LV afterload). In patients with persistent cardiogenic shock and VSR, short-term MCS to divert flow away from the shunt can be an effective strategy. LV-to-aorta or LA-to-arterial MCS may provide the best single-device hemodynamic profiles by decreasing shunt flow, reducing pulmonary capillary wedge pressure, and improving blood pressure. Surgical and percutaneous VSD repair are the definitive treatment options. If able to stabilize patients and pursue delayed repair,
In this episode of the podcast, we will discuss the current management of Acute Pulmonary Embolism. Our guest is Dr. Belinda Rivera-Lebron, a pulmonary critical care physician who practices at the University of Pittsburgh Medical System. She is an Associate Professor of Medicine and is the Director of the UPMC Acute Pulmonary Embolus (PE) Program and the UPMC Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Program. Dr. Rivera-Lebron's areas of interest include pulmonary embolism and pulmonary hypertension. Additional Resources Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium.: https://pubmed.ncbi.nlm.nih.gov/31185730/ AHA Scientific Statement. Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: https://pubmed.ncbi.nlm.nih.gov/36688837/ PERT Consortium website: https://pertconsortium.org/ Books Mentioned in this Episode: The Trusted Advisor. By David H. Meister, et al: bit.ly/3mq9Oap
Commentary by Dr Varinder Randhawa
Unlike other businesses at Medtronic, the Mechanical Circulatory Support group isn't measured by the number of new patients receiving medical devices. Instead, MCS is charged with caring for the nearly 3,000 patients who have already been implanted with Medtronic's Heartware Ventricular Assist Device (HVAD.) In 2021, Medtronic stopped distributing the HVADs following studies that showed recipients had a higher risk of suffering strokes than those who were implanted with another company's VAD. But Medtronic's mission didn't end with the suspension. In this episode, Raj Thomas, vice president and general manager of MCS, explains how his team continues to support recipients, their caregivers and clinicians to help ensure those heart failure patients can live the fullest lives possible. Thomas details MCS's steps toward providing support including the organization of a global meeting and the establishment of a patient advisory board. Thank you to Resonant Link for sponsoring this episode. Thank you for listening to this episode of the MedtronicTalks Podcast. Subscribe to this podcast on any major podcast application.
“Sham peer review or malicious peer review is defined as the abuse of a medical peer review process to attack a doctor for personal or other non-medical reasons.” “Most doctors — warns Dr Kaki — do not understand that ultimately your privileges are not dictated by your colleagues through a fair process, but hospital administration controls our destiny”. In 2018, Dr Kaki was subject to a campaign of retaliation that set out to revoke the well-respected cardiologist's privileges. Today, Dr Kaki is Director of Mechanical Circulatory Support at Ascension and Clinical Associate Professor at Wayne State University School of Medicine. In this week's Parallax Dr Kalra's guests are the team that fought for justice in Dr Kaki's case: Dr Lawrence R Huntoon, Editor-in-Chief of the Journal of the Association of American Physicians and Surgeons and Deborah Gordon, employment attorney. Dr Kaki walks us through his Kafkaesque experience and the knowledge he acquired during his battle with his former hospital. We get insight into the stages of a peer review process and the role of key stakeholders. Dr Huntoon, expert in this field, helps us put Dr Kaki's experience in context and talks about the prevalence of sham peer reviews through shocking cases. Ms Gordon supports the discussions with practical tips and insights on the role of an attorney. Join Ankur and his guests for a must listen show on your rights as a physician. What do you need to know about the hospital peer review process and your rights? What can you do if targeted? What is Dr Kaki's advice to physicians? Stay tuned for Part 2 of Parallax's Medico-Legal series with Dr Kalra and Dr Huntoon. Resource: https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.12903 Questions and comments can be sent to “podcast@radcliffe-group.com” and may be answered by Ankur in the next episode. Guests: @DrAmirKaki, Dr Lawrence R Huntoon and Deborah Gordon host: @AnkurKalraMD and produced by: @RadcliffeCARDIO.
Cardiogenic shock (CS) remains a complex, multifactorial syndrome associated with significant morbidity and mortality. The CardioNerds Critical Care Cardiology Series tackles this important syndrome in a series of several episodes including: LV-predominant Shock, RV-predominant Shock, and Bi-ventricular Shock. In this episode, we review the definitions, pathophysiology, evaluation, and contemporary management, including use of inotropes and mechanical circulatory support, of left ventricular (LV) predominant CS. Series co-chairs Dr. Eunice Dugan and Dr. Karan Desai along with CardioNerds Co-founders Dr. Amit Goyal and Dr. Daniel Ambinder were joined by FIT lead, Dr. Vanessa Blumer, the recipient of the AHA 2021 Laennec Fellow in Training Clinician Award and currently pursuing Advanced Heart Failure and Transplant fellowship at the Cleveland Clinic. Our episode expert is Dr. Shashank Sinha, an Advanced Heart Failure, Mechanical Circulatory Support, and Cardiac Transplant cardiologist, Medical Director of the Cardiac Intensive Care Unit, and Director of the Cardiovascular Critical Care Research Program at INOVA Fairfax Hospital. His illustrious career accomplishments include being a Steering Committee member and site Principal Investigator for the multicenter Cardiogenic Shock Working Group and Critical Care Cardiology Trials Network. Audio editing by CardioNerds academy intern, Anusha Gandhi. The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - LV Predominant Cardiogenic Shock LV-CS is complex! It is important to recognize that the pathophysiology of heart failure-related cardiogenic shock (HF-CS) is distinct from that of acute myocardial infarction (AMI-CS), and also crucial to differentiate between LV-dominant, right ventricular (RV)-dominant and biventricular (BiV)-shock.The SCAI SHOCK Stage Classification provides a unified and standardized vocabulary when assessing severity of CS, and facilitates communication about the diagnosis, presentation, and evolving nature of CS.Norepinephrine is considered the initial vasopressor of choice in most CS patients; the initial inotrope choice is a bit more nuanced!When considering mechanical circulatory support (MCS) for LV shock, high-quality data to guide therapy is lacking but one must always consider “the right patient, for the right device, at the right time” and remember that “pumps pump blood, decisions save lives”.Multidisciplinary, team-based care is paramount to improving survival of the critically ill patient with CS. Show notes - LV Predominant Cardiogenic Shock 1. What tools do you use to define LV CS? CS is a hemodynamically complex and multifactorial syndrome, one of the most common indications for admission to a cardiac intensive care unit, with short-term mortality ranging from 35-50%.It is defined by systemic hypoperfusion and tissue hypoxia due to a primary cardiac insult or dysfunction.Clinical criteria used to define CS typically include evidence of hypotension (classically defined as SBP < 90 mmHg for 30 minutes and/or use of vasopressors, inotropes, or MCS to maintain systolic blood pressure > 90 mmHg) AND evidence of end-organ hypoperfusion (for example, serum lactic acid > 2 mmol/L, acute kidney injury, acute liver injury, altered mental status) in the setting of acute coronary syndrome or acute decompensated heart failure.Laboratory markers, including serum lactic acid, liver function tests,
Join Dr. Frances Mae West, Dr. Charles Grodzin, Dr. Emily Gundert, Dr. Jim Horowitz, & Dr. Alison Witkin as they recap mechanical measures to achieve hemodynamic stability, including ecmo and right ventricular support.
It's another session of CardioNerds Rounds! In these rounds, Co-Chairs, Dr. Karan Desai and Dr. Natalie Stokes and Dr. Tiffany Dong (FIT at Cleveland Clinic) joins Dr. Randall Starling (Professor of Medicine and Director of Heart Transplant and Mechanical Circulatory Support at Cleveland Clinic) to discuss the nuances of guideline directed medical therapy (GDMT) through real cases. As a past president of the Heart Failure Society of America (HFSA) and author on several guidelines, Dr. Starling gives us man pearls on GDMT. Come round with us today by listening to the episodes and joining future sessions of #CardsRounds! This episode is supported with unrestricted funding from Zoll LifeVest. A special thank you to Mitzy Applegate and Ivan Chevere for their production skills that help make CardioNerds Rounds such an amazing success. All CardioNerds content is planned, produced, and reviewed solely by CardioNerds. Case details are altered to protect patient health information. CardioNerds Rounds is co-chaired by Dr. Karan Desai and Dr. Natalie Stokes. Speaker disclosures: None Cases discussed and Show Notes • References • Production Team CardioNerds Rounds PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Show notes - CardioNerds Rounds: Challenging Cases - Modern Guideline Directed Therapy in Heart Failure with Dr. Randall Starling Case #1 Synopsis: A man in his 60s with known genetic MYPBC3 cardiomyopathy and heart failure with a reduced ejection fraction of 30% presents with worsening dyspnea on exertion over the past 6 months. His past medical history also included atrial fibrillation with prior ablation and sick sinus syndrome with pacemaker implantation. Medications are listed below. He underwent an elective right heart catheterization prior to defibrillator upgrade for primary prevention. At the time of right heart catheterization, his blood pressure was 153/99 with a heart rate of 60. His RHC demonstrated a RA pressure of 15mmHg, RV 52/16, PA 59/32 (mean 41), and PCWP 28 with Fick CO/CI of 2.8 L/min and index of 1.2 L/min/m2. His SVR was 1900 dynes/s/cm-5. He was admitted to the cardiac ICU and started on nitroprusside that was transitioned to a regimen of Sacubitril-Valsartan and Eplerenone. His final RHC numbers were RA 7, PA 46/18/29, PCWP 16 and Fick CO/CI 6.1/2.6. His discharge medications are shown below. Takeaways from Case #1 Unless there are contraindications (cardiogenic shock or AV block), continue a patient's home beta blocker to maintain the neurohormonal blockade benefits. A low cardiac index should be interpreted in the full context of the patient, including their symptoms, other markers of perfusion (e.g., urine output, mentation, serum lactate), and mean arterial pressure before holding or stopping beta blockade. Carvedilol, metoprolol succinate and bisoprolol are all evidence-based options for beta blockers in heart failure with reduced ejection fraction.If there is concern of lowering blood pressure too much with Sacubitril/Valsartan, one method is to trial low dose of valsartan first and then transition to Sac/Val. Note, in the PARADIGM-HF trial, the initial exclusion criteria for starting Sac/Val included no symptomatic hypotension and SBP ≥ 100. At subsequent up-titration visits, the blood pressure criteria was decreased to SBP ≥ 95.In multiple studies, protocol-driven titration of GDMT has shown to improve clinical outcomes, yet titration remains poor. The following image from Greene et al. in JACC shows that in contemporary US outpatient practices that GDMT titration is poor with few patients reaching target dosing. Case #2 Synopsis: A 43 year-old male with a past medical history of familial dilated cardiomyopathy requiring HVAD placement two years prior now comes in with low flow alarms.
We all know that heart disease is the number 1 killer worldwide. And patients die either because of acute coronary syndromes (myocardial infarction) or because of left ventricular dysfunction (heart failure). And, as an interventionist, being trapped with both evils; severe coronary stenosis and left ventricular dysfunction is scary. The only solution then is usually revascularization but it also comes with risks of myocardial injury and impaired organ perfusion. There is already an entire system with bypass surgery that perfuses the organs while the heart is paralyzed, the bypass machine. Unfortunately, surgery is not always available, many patients refuse surgery, and others may be declined by the surgeons because of their high risk. Here, cath interventions are the only hope. In addition to the gadgets available to handle the coronary occlusions, there is a need for devices to support the circulation and blood pressure during cardiogenic shock or when the heart is stunned during complex coronary intervention. The last thing we want is to have a patient crashing on-table or shortly after.And to review these devices that support the heart and the circulation in complex PCI (I call them the guardian in the cath lab), I am glad to host today one of the International experts on complex coronary interventions and mechanical circulatory support. Dr. Lorenzo Azzalini. Dr. Azzalini is the Director of the Complex Coronary Interventions Program and associate professor of medicine at Virginia Commonwealth University, in Richmond, VA. Before joining VCU he was co-director of the chronic total occlusion program at San Raffaele Hospital in Milan, Italy. And San Rafaelle was one of the centers of excellence in Europe. Dr. Azzalini's clinical and research expertise is represented by chronic total occlusion PCI, atherectomy, mechanical circulatory support, and acute kidney injury after PCI. He has over 170 international publications, more than 3700 citations, has received numerous international awards, is a member of the editorial board of the Canadian Journal of Cardiology, Eurointervention, Cardiovascular Revascularization Medicine, and Minerva Cardiology and Angiology, and is a guest reviewer for other twenty journals. And he is a wiz inside the cath lab. I had the chance to work with him several times in the cath lab and I would describe his skills as amazing.
Dr. Curtis Prejean talks to us about cardiogenic shock and mechanical circulatory support.
Dr. Curtis Prejean talks to us about cardiogenic shock and mechanical circulatory support.
Commentary by Dr. Valentin Fuster
In the first half of the show, Dr. Brian Lima, Surgical Director of Heart Transplantation and Mechanical Circulatory Support at Medical City Heart Hospital talks about the breakthrough new procedure first performed in December at the Hospital - the Donation After Cardiac Death (DCD) Transplant. As Dr. Lima describes, this procedure has been performed in very few locations in the US, after originating in Europe about 2 years ago. This was the first of its kind in Texas and once again the DFW Metroplex shows its brilliance as a center of medical excellence. Dr. Lima walks us through this procedure that literally revives a deceased heart in order to save another's life. We continue the theme with Dr. Tiffany Simms-Waldrip, Clinical Director of Stem Cell Transplant at Children's Health and Associate Professor at UT Southwestern Medical Center. She talks about a national database registry where people like you and I can register to donate stem cells that could possibly safe a child's life. The program is called "Be The Match" and is a wonderful way to know that your willingness to be a stem cell donor could give a child somewhere in the US another chance at life. The link for "Be The Match" is https://bethematch.org/ See acast.com/privacy for privacy and opt-out information.
In this episode, Dr. Gillian Beauchamp sits down with Dr. Susanna Byram to discuss the use of VV and VA ECMO and other Mechanical Circulatory Support Devices in poisoned patients.
Dr. Ashish Shah is the Alfred Blalock Endowed Director and Chair, Department of Cardiac Surgery, and director of Heart Transplant and Mechanical Circulatory Support at Vanderbilt. He is the driving force behind the nation's busiest heart transplant center. Vanderbilt does more heart transplants than any hospital in the world. February is American Heart Month, and in today's conversation, Dr. Shah and I do a deep dive on heart health and the latest in transplantation – the miraculous, life-giving procedure that is rapidly evolving with today's cutting-edge science. We cover pig hearts, novel “heart in a box” technology, and medical progress that once sounded like science-fiction. Additional Resources: Below are the videos cited in today's show re: Vivien Thomas: American Experience “Partners of the Heart” (TV Episode 2002) - https://www.imdb.com/title/tt0328241/ “Something the Lord Made,” HBO Movie, 2007 - https://amzn.to/3uJngIE Vivien Thomas, “Partners of the Heart: Vivien Thomas and His Work with Alfred Blalock: An Autobiography,” 1998 - https://amzn.to/3rMSQn5 Gwendolyn Hooks & Colin Bootman, “Tiny Stitches: The Life of Medical Pioneer Vivien Thomas,” Children's book, 2016 - https://amzn.to/3LvUDof
In this episode we welcome back Dr. Jay Pal our new Surgical Director of MCS and Transplant.4:00 VAD's past & present 5:16 Patients & VAD 7:34 Future VADS 8:43 Artificial Heart 12:24 Surgery In's and Out's 14:35 Best Practices from Experience 17:00 Why Back to UW? 18:41 What's in the water at Duke? 20:10 Regional Partners 21:20 Partnering with Complexity in Care 24:16 Future of VADs 27:20 Thoughts on Allocation Changes 29:45 Nepal 37:32 Personal Benefits of Global Health Jay Pal, MD, PhD is the Surgical Director of the Heart Transplantation and Mechanical Circulatory Support programs in the Division of Cardiothoracic Surgery. His clinical and research interests lie in the surgical treatment of heart failure, including transplantation and mechanical circulatory support systems.He completed his general surgical residency at the UCSF Easy Bay program and his thoracic surgery residency at Duke University, where he developed an interest in heart failure. He has held faculty positions at the University of Texas Health Science Center San Antonio and the University of Colorado, as well as at the UW School of Medicine from 2013-2017.In addition, Dr. Pal has been coordinating an international medical effort in Nepal for several years and will continue this work in collaboration with the Department of Global Health at the University of Washington.He can be reached any time at jaydpal@uw.eduor you can use our digital front door: https://hipaa.jotform.com/uwheart/referralsThanks for listening!
In this “Breathe Easy Critical Perspective” podcast, Dr. Dominique Pepper interviews Dr. Jose Diaz-Gomez. They discuss Dr. Diaz-Gomez's recent publication in the NEJM about the use of point of care ultrasound (POCUS) in the ICU. Dr. Diaz-Gomez is the Medical Director of Cardiothoracic, Mechanical Circulatory Support and Critical Care at Baylor St Luke's Medical Center in Houston, Texas.
The CardioNerds are thrilled to launch The Cardiac Critical Care Series! The series Co-Chairs – Dr. Mark Belkin (Advanced Heart Failure FIT, U Chicago), Dr. Yoav Karpenshif (FIT, U Penn), Dr. Eunice Dugan (CardioNerds Academy Chief Fellow and FIT, Cleveland Clinic), and Dr. Karan Desai (CardioNerds Academy Editor and FIT, U Maryland) - join CardioNerds Co-Founders, Amit Goyal and Daniel Ambinder to delve into high-yield topics in critical care cardiology. We kickstart this series with one of the early pioneers and national leaders in cardiac critical care – Dr. Jason Katz, Director of Cardiovascular Critical Care and Co-Director of Mechanical Circulatory Support and the CICU at Duke University Medical Center. In this episode, we learn about Dr. Katz's career path and what motivated him to train in Critical Care Cardiology. He shares early struggles, notable changes in this field's nascent period, and ongoing challenges in training and practice. We discuss collaboration with other cardiac and non-cardiac specialties and their importance in comprehensive care. Furthermore, we discuss how to advance critical care research, including the Critical Care Cardiology Trials Network and future randomized controlled trials to inform our practice and develop standardized protocols. In this small but rapidly growing field, we learn there is much to discover together. Audio editing by CardioNerds Academy Intern, Hirsh Elhence. Claim free CME for enjoying this episode! Disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes “I think it's really important not to be afraid of change in order to potentially succeed [...] it's okay to not entirely know what you want to do.” - Dr. Katz when sharing his non-direct career path in a novel field.“There is no greater team sport in cardiology than Cardiac Critical Care” and “I oftentimes think of the Critical Care Cardiologist as sort of the conductor that helps to orchestrate [the team]...” - Dr. Katz when discussing the importance of multidisciplinary teams and need to collaborate with other cardiac and non-cardiac sub-specialties.Many general surgical or medical residency/fellowship graduates are not comfortable caring for patients in the critical care setting. There is a need to revamp critical care training without significantly prolonging training time in order to complement and enhance our current workforce to care for complex, critically ill cardiac patients.“I don't think there's necessarily a one size fits all model, and I think we should be malleable or adaptable to the needs of our trainees and the needs of our patients.” - Dr. Katz when discussing training pathways in Critical Care Cardiology or combining Critical Care with other subspecialties like Interventional Cardiology or Advanced Heart Failure.Dr. Katz suggests that when choosing a Critical Care Cardiology training program: “consider geography, the flexibility of the curriculum, the overall fellowship and social experience, and the clinical setting. Everything that's really important to choosing a cardiology fellowship is more important in my mind than if they actually have a standardized, cardiac critical care pathway.” Show notes 1. What are some recent changes in the field of Critical Care Cardiology? Compared to even just a decade ago, there is a growing interest from medical students to young faculty in pursuing a career in critical care cardiology.At the same time there is evidence that the patient demographics in our CICUs are changing, including more multi-organ dysfunction and many non-cardiac diagnoses. In a recent paper from the Critical Care Cardiology Trials Network (CCCTN),
In this episode, Dr. Gary Sherman has a most informative discussion about heart failure with one of the foremost experts on heart failure in the country, Dr. Nandini Nair. Dr. Nair earned her Ph.D. in biochemistry at the Indian Institute of Science, in Bangalore, India. She earned her medical degree in 2000, at George's University School of Medicine, Grenada, WI. Dr. Nair then came to the United States to Drexel University College of Medicine, in Philadelphia, PA, for her Residency in Internal Medicine during the years 2000-2003. In 2007-2008, she completed a fellowship in Advanced Heart Failure and Transplant Cardiology at Stanford University School of Medicine, Palo Alto, in California. It was then, that Dr. Nair went onto Brown University School of Medicine, in Providence, RI, and earned her EMHL (Exec. Masters in Healthcare Leadership) during the years 2019-21. Now- has completed 14 years post-fellowship experience as Medical Director of Advanced Heart Failure, Mechanical Circulatory Support, and Cardiac Transplantation.Wow!! We are so privileged to be able to learn from Dr. Nair's vast education and experience. Do not miss this intriguing episode!
EMS A to Z: Mechanical Circulatory Support Devices Show Notes: From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn There are two types of mechanical circulatory support devices: Left Ventricular Assist Devices (LVAD) and Total Artificial Heart (TAH). Left Ventricular Assist Device: An LVAD is a Mechanical Circulatory Support (MCS) device designed to restore blood flow and improve survival, functional status, and quality of life for those suffering from advanced heart failure. The device is implanted in parallel with the heart, taking over a majority of its circulatory function. An LVAD is often implanted as a temporary treatment, but is sometimes used as a permanent solution to very low cardiac output. What are the reasons for VAD implantation? Bridge to Transplant The patient must meet criteria to be listed for a heart transplant Destination Therapy The patient does not qualify for a heart transplant but meets criteria for Destination Therapy The patient lives the rest of their life with an VAD Bridge to Recovery VAD for a few days or weeks, provides temporary supportto a patient expected to recover native heart function What are the special considerations for LVAD patients? Routine assessments such as blood pressure, pulses, and pulse-oximetry may not be unattainable Chest compressions are usuallynot indicated The patients carry external equipment: a controller and power sources that operate the implanted pump though a single driveline How do you assess patients with LVADS? Attempt to auscultate over the apex of the heart for a “whirling” or “smooth, humming” sound indicating that the VAD is working A cable exits the abdominal wall that connects the device to power and the control unit Many VAD patients also have an implanted cardiac defibrillator Blood Pressure (BP) - BP taken with a manual cuff; Automatic BP readings are considered unreliable Pulse - A palpable pulse is variable and clinically insignificant in VAD patients Pulse Oximetry- Can be unreliable Look for physical s/s of ↓ oxygenation EKG is typically unaffected What types of problems are LVAD patients at risk for? Bleeding complications due to blood thinner use Arrhythmias VAD flows may be affected Infection (as with any implanted device) How do you treat arrhythmias in LVAD patients? Many VAD patients have an ICD / Pacemaker Persistent arrhythmias are treated aftercontacting the VAD coordinator Okay to defibrillate & cardiovert VAD patients per ACLS protocol Okay to administer anti-arrhythmic medications per ACLS protocol What are the differences between LVADs and Total artificial hearts? An ECG is meaningless since there is no heart Pulse oximetry is accurate A regular BP measurement may be obtained Chest compressions are not performed Cardioversion or defibrillation are not performed
Dr. Darshak Karia, Director of Mechanical Circulatory Support Devices and the Heart Failure Program at University Hospital Augusta in Georgia, joined the podcast to talk about virtual care, market consolidation and workforce issues for cardiology.
Dr. Kermit goes on call with Dr. Brian Lima, Surgical Director of Heart Transplantation and Mechanical Circulatory Support at Medical City Dallas Heart Hospital in Dallas, Texas. They discuss Dr. Lima's book, "Heart to Beat," wherein he details his inspiring story. He is the son of Cuban immigrants who became a successful cardiothoracic surgeon. Dr. Lima's mantra is: success is not reserved for the smartest or most talented--it's earned by those who want it the most.
Welcome back to JHLT: The Podcast and our round table talks. Daniel R. Goldstein, MD, Editor-in-Chief of the Journal of Heart and Lung Transplantation, leads a discussion with the JHLT Digital Media Editors focusing on topics from the April issue of JHLT. In this episode, we are happy to welcome our first-ever guest, David Peng, MD, Director of Pediatric Heart Failure and Mechanical Circulatory Support at the University of Michigan. Starting at 1:45, Van-Khue Ton, MD, PhD, and Marty Tam, MD, are in discussion with David on a timely paper by Dr. Danielle Sganga and colleagues, titled “Comparison of combined heart-liver vs heart-only transplantation in pediatric and young adult Fontan recipients.” Starting at 12:10, Erika Lease, MD, and David Schibilsky, MD, discuss a study from Bidar and colleagues called “Venous or arterial thromboses after venoarterial extracorporeal membrane oxygenation and support: Frequency and risk factors.” Follow along in the April issue at www.jhltonline.org/current. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.com.
Join cardiology fellow Dr. Kaushik Amancherla and faculty discussant Dr. Andrew DeFilippis as they review the approach to mechanical circulatory support!
A lecture by Shalin Patel, MD FACC on the Mechanical Circulatory Support for Cardiogenic Shock during the 2nd Annual ResusCon 2019 at the Grandview, September 4, 2019 @VassarCME @VBMCEMS @2019ResusCon
Commentary by Dr. Valentin Fuster
FDA 治疗高度耐药肺结核的新药NEJM 巴罗萨韦对流感家庭接触者的流感预防效果医学前沿 支气管低温冷冻术和支气管流变成形术治疗慢性支气管炎普托马尼（pretomanid）普托马尼（pretomanid）是一种新型的口服硝基咪唑嗪类抗菌药。2019年8月，普托马尼被批准作为BPaL方案（贝达喹啉、 普托马尼和利奈唑胺）和BPaMZ（贝达喹啉、 普托马尼、莫西沙星和吡嗪酰胺）方案的一部分用于治疗耐药性肺结核。《开放标签单组研究：高度耐药肺结核的治疗》New England Journal of Medicine，2020年3月 (1)这项开放标签、单组研究的目的是评价贝达喹啉、普托马尼和利奈唑胺联合26周治疗广泛耐药结核病患者、以及治疗无效或因副作用而停用二线治疗方案的多药耐药结核病患者的安全性和疗效。共计109例患者被纳入本研究，治疗结束后6个月时，90%的患者结局良好。11例不良结局包括：7例死亡，2例在随访期间复发。利奈唑胺的预期毒性作用包括周围神经病（81%）和骨髓抑制（48%），这些毒性作用虽然常见，但可以控制，常导致利奈唑胺减量或中断用药。结论：在高度耐药结核病患者中，在治疗结束后6个月时，贝达喹啉、普托马尼和利奈唑胺联合治疗使高比例的患者有良好结局。流行性感冒流行性感冒是甲型或乙型流感病毒导致的急性呼吸道疾病，在世界范围内引起爆发和流行，主要发生在冬季。患者出现上呼吸道和/或下呼吸道受累的症状，伴有全身症状，如发热（37.8°C-40.0°C）、头痛、肌痛和无力。一般人群中流感属于自限性疾病，高危人群中并发症和死亡率增加。流感通过大颗粒飞沫和小颗粒气溶胶传播，潜伏期1-4天，无并发症的患者病程持续1周左右，病毒排出时间为病毒暴露后0.5天到7天，病毒排出的高峰在第2天。高危人群包括：年龄≥65岁，妊娠或产后2周，住在长期护理机构，美国印第安人和阿拉斯加原住民，极端肥胖者（BMI≥40kg/m2)，慢性疾病患者，糖皮质激素或免疫抑制治疗的患者。《回顾观察性研究：老年人流感疫苗接种对住院和死亡率的影响》Annual of Internal Medicine，2020年4月 (2)65岁以上的老年人接种疫苗有临床获益的证据非常缺乏，研究者设计了一项“断点回归”分析，他们通过英国7个大型临床数据库分析了疫苗接种率和流感相关疾病。研究发现成人疫苗接种率在65岁这一年，从34%提高至57%。重度呼吸系统疾病均随着年龄的增长而升高，平滑地通过了65岁这一门槛，没有出现急剧下降。假如每年接种流感疫苗的确能给65岁以上的老年人带来明显临床益处的话，预期应出现急剧下降。结论：老年人接种流感疫苗充其量只有很小的直接获益。《双盲随机对照研究：巴罗萨韦对流感家庭接触者的流感预防效果》New England Journal of Medicine，2020年7月 (3)巴罗萨韦在家庭环境中的暴露后预防效果尚不明确。这项多中心、双盲、随机、安慰剂对照试验，在确诊流感病例的545个家庭的752个接触者中，将参与者随机分为两组，分别接受巴罗萨韦或安慰剂单剂给药。巴罗萨韦预防组患临床流感显著低于安慰剂组（1.9% vs. 13.6%；P＜0.001）。巴罗萨韦在高危、儿童和未接种疫苗的参与者的亚组中有效。两组的不良事件发生率相似（巴洛沙韦组22.2%和安慰剂组20.5%）。结论：单剂巴罗萨韦显示出显著的流感病毒暴露后预防效果。流行性感冒的治疗抗病毒治疗包括：神经氨酸酶抑制剂（奥司他韦、扎那米韦和帕拉米韦），流感病毒cap-依赖性核酸内切酶选择性抑制剂巴罗萨韦（baloxavir），金刚烷胺类（金刚烷胺和金刚乙胺）。《开放标签随机对照研究：流感样疾病的治疗中加用奥司他韦的疗效研究》Lancet，2020年1月 (4)研究目的是确定流感样疾病患者在常规初级护理中加入奥司他韦抗病毒治疗是否会缩短康复时间。这项开放标签的、实用的、适应性的、随机对照试验中，将奥司他韦添加到常规治疗中。研究纳入3266名参与者，其中52%经证实感染了流感。总体而言，奥司他韦组的患者恢复时间较短，绝对缩短1.20天。对于没有合并症的、
FDA 治疗高度耐药肺结核的新药NEJM 巴罗萨韦对流感家庭接触者的流感预防效果医学前沿 支气管低温冷冻术和支气管流变成形术治疗慢性支气管炎普托马尼（pretomanid）普托马尼（pretomanid）是一种新型的口服硝基咪唑嗪类抗菌药。2019年8月，普托马尼被批准作为BPaL方案（贝达喹啉、 普托马尼和利奈唑胺）和BPaMZ（贝达喹啉、 普托马尼、莫西沙星和吡嗪酰胺）方案的一部分用于治疗耐药性肺结核。《开放标签单组研究：高度耐药肺结核的治疗》New England Journal of Medicine，2020年3月 (1)这项开放标签、单组研究的目的是评价贝达喹啉、普托马尼和利奈唑胺联合26周治疗广泛耐药结核病患者、以及治疗无效或因副作用而停用二线治疗方案的多药耐药结核病患者的安全性和疗效。共计109例患者被纳入本研究，治疗结束后6个月时，90%的患者结局良好。11例不良结局包括：7例死亡，2例在随访期间复发。利奈唑胺的预期毒性作用包括周围神经病（81%）和骨髓抑制（48%），这些毒性作用虽然常见，但可以控制，常导致利奈唑胺减量或中断用药。结论：在高度耐药结核病患者中，在治疗结束后6个月时，贝达喹啉、普托马尼和利奈唑胺联合治疗使高比例的患者有良好结局。流行性感冒流行性感冒是甲型或乙型流感病毒导致的急性呼吸道疾病，在世界范围内引起爆发和流行，主要发生在冬季。患者出现上呼吸道和/或下呼吸道受累的症状，伴有全身症状，如发热（37.8°C-40.0°C）、头痛、肌痛和无力。一般人群中流感属于自限性疾病，高危人群中并发症和死亡率增加。流感通过大颗粒飞沫和小颗粒气溶胶传播，潜伏期1-4天，无并发症的患者病程持续1周左右，病毒排出时间为病毒暴露后0.5天到7天，病毒排出的高峰在第2天。高危人群包括：年龄≥65岁，妊娠或产后2周，住在长期护理机构，美国印第安人和阿拉斯加原住民，极端肥胖者（BMI≥40kg/m2)，慢性疾病患者，糖皮质激素或免疫抑制治疗的患者。《回顾观察性研究：老年人流感疫苗接种对住院和死亡率的影响》Annual of Internal Medicine，2020年4月 (2)65岁以上的老年人接种疫苗有临床获益的证据非常缺乏，研究者设计了一项“断点回归”分析，他们通过英国7个大型临床数据库分析了疫苗接种率和流感相关疾病。研究发现成人疫苗接种率在65岁这一年，从34%提高至57%。重度呼吸系统疾病均随着年龄的增长而升高，平滑地通过了65岁这一门槛，没有出现急剧下降。假如每年接种流感疫苗的确能给65岁以上的老年人带来明显临床益处的话，预期应出现急剧下降。结论：老年人接种流感疫苗充其量只有很小的直接获益。《双盲随机对照研究：巴罗萨韦对流感家庭接触者的流感预防效果》New England Journal of Medicine，2020年7月 (3)巴罗萨韦在家庭环境中的暴露后预防效果尚不明确。这项多中心、双盲、随机、安慰剂对照试验，在确诊流感病例的545个家庭的752个接触者中，将参与者随机分为两组，分别接受巴罗萨韦或安慰剂单剂给药。巴罗萨韦预防组患临床流感显著低于安慰剂组（1.9% vs. 13.6%；P＜0.001）。巴罗萨韦在高危、儿童和未接种疫苗的参与者的亚组中有效。两组的不良事件发生率相似（巴洛沙韦组22.2%和安慰剂组20.5%）。结论：单剂巴罗萨韦显示出显著的流感病毒暴露后预防效果。流行性感冒的治疗抗病毒治疗包括：神经氨酸酶抑制剂（奥司他韦、扎那米韦和帕拉米韦），流感病毒cap-依赖性核酸内切酶选择性抑制剂巴罗萨韦（baloxavir），金刚烷胺类（金刚烷胺和金刚乙胺）。《开放标签随机对照研究：流感样疾病的治疗中加用奥司他韦的疗效研究》Lancet，2020年1月 (4)研究目的是确定流感样疾病患者在常规初级护理中加入奥司他韦抗病毒治疗是否会缩短康复时间。这项开放标签的、实用的、适应性的、随机对照试验中，将奥司他韦添加到常规治疗中。研究纳入3266名参与者，其中52%经证实感染了流感。总体而言，奥司他韦组的患者恢复时间较短，绝对缩短1.20天。对于没有合并症的、
To watch the discussion follow the link below:New Directions in Stem Cell Therapies for the Heart (Reza Ardehali, MD, PhD) We’d love to hear your thoughts and questions about stem cells and cardiac regeneration research, so feel free to keep the conversation going online. You can tweet us at @debakeyCVedu with #CVnow.speakers on this episode:Reza Ardehali, MD, PhDAssociate Chief of Cardiology, Regenerative MedicineAdvanced Heart Failure, Mechanical Circulatory Support, and TransplantationBroad Stem Cell Research Center, UCLA School of Medicine John Cooke, MD, PhDChair, Department of Cardiovascular SciencesDirector, Center for Cardiovascular RegenerationHouston Methodist
Diving into the world of mechanical circulatory support and right ventricular assist devices, I'd like to introduce you to the ProtekDuo. I learned about this device while creating a lecture titled "Cardiogenic Shock: Rise of the Machines". Chances are that you'll more likely than not be caring for a patient with one of these sooner rather than later. Better to familiarize yourself with it now. Show Notes: https://eddyjoemd.com/protekduo/ Receive a FREE audiobook (TWO for Amazon Prime members) with your FREE 30-day trial by using my link for Audible: CLICK HERE! You will be reminded when your trial is ending, by the way.
Commentary by Dr. Valentin Fuster
Medical experts and a patient discuss life-saving advanced technology that helps patients with severe heart and lung problems
Medical experts and a patient discuss life-saving advanced technology that helps patients with severe heart and lung problems
Mechanical circulatory support (MCS) devices are becoming more prevalent and sophisticated with each passing year. In this episode, I’ll briefly cover some of the basics for intra-aortic balloon pumps (IABPs), Impella, CentriMag, ProtekDuo, TANDEMHEART, and ECMO. As always, drop me a comment with your questions and thoughts! Here are some of my other posts to …
Mechanical circulatory support (MCS) devices are becoming more prevalent and sophisticated with each passing year. In this episode, I’ll briefly cover some of the basics for intra-aortic balloon pumps (IABPs), Impella, CentriMag, ProtekDuo, TANDEMHEART, and ECMO. As always, drop me a comment with your questions and thoughts! Here are some of my other posts to …
Mechanical circulatory support (MCS) devices are becoming more prevalent and sophisticated with each passing year. In this episode, I’ll briefly cover some of the basics for intra-aortic balloon pumps (IABPs), Impella, CentriMag, ProtekDuo, TANDEMHEART, and ECMO. As always, drop me a comment with your questions and thoughts! Read More »
Mechanical circulatory support (MCS) devices are becoming more prevalent and sophisticated with each passing year. In this episode, I’ll briefly cover some of the basics for intra-aortic balloon pumps (IABPs), Impella, CentriMag, ProtekDuo, TANDEMHEART, and ECMO. As always, drop me a comment with your questions and thoughts! Read More »
Mechanical circulatory support (MCS) devices are becoming more prevalent and sophisticated with each passing year. In this episode, I’ll briefly cover some of the basics for intra-aortic balloon pumps (IABPs), Impella, CentriMag, ProtekDuo, TANDEMHEART, and ECMO. As always, drop me a comment with your questions and thoughts! […]
Mechanical circulatory support (MCS) devices are becoming more prevalent and sophisticated with each passing year. In this episode, I’ll briefly cover some of the basics for intra-aortic balloon pumps (IABPs), Impella, CentriMag, ProtekDuo, TANDEMHEART, and ECMO. As always, drop me a comment with your questions and thoughts! […]
Taking Cardiogenic Shock Management to the next level...
Heart Failure and Mechanical Circulatory Support
Dr Amit Khera: Welcome to Circulation On The Run. Our weekly podcast summary and backstage pass to the Journal. I'm Dr Amit Khera, associate editor and digital strategies editor from UT Southwestern Medical Center in Dallas, and I had the distinct privilege of standing in for Dr Carolyn Lam and Greg Hundley this week. Twice a year, we are very fortunate to have some unique podcasts when we don't have circulation issues, and in the past we've met with many fellows in training and heard about some interesting studies that they're doing. Today we have a very special podcast we have not done before, and that is one where we had the opportunity to learn about our Circulation Family of Journals, and more importantly to hear from the dynamic editors in chief of these various journals. I think you're really going to enjoy it, we'll walk through and hear from each one of them, hear about some of the innovative things that are happening, some of the future that they see for their journal in their field, and I really enjoyed it, and I'm sure you will as well. So, without further ado, we'll start with our first editor. Dr Sunil Rao: I'm Sunil Rao. I'm an intervention cardiologist at Duke, and I'm the Editor-in-Chief for Circulation Cardiovascular Interventions, which is one of the daughter journals of the Circulation Family. We publish articles really related to the broad spectrum of interventional cardiology, from coronary interventions to peripheral arterial disease, and Endovascular interventions to structural heart disease interventions. We also published review articles in all of those areas, as well as any health policy or outcomes studies that are in that space. Dr Amit Khera: Tell us what are some of the innovative things that your journal is doing this year. Dr Sunil Rao: We're really excited about two things, one is our extremely successful Assistant Editor program that we launched last year at A.H.A. 2018. This is a program where we have five early career individuals that are within five years of completing their fellowship program who joined the editorial team at Circulation Cardiovascular interventions, and in that role they really learn a lot about the mechanics of how scientific publishing works, they commit to doing manuscript reviews, and receive feedback on improving their peer review process, and even independently handles some manuscripts as well, that are in their areas of interest. This is our way, I think, of encouraging the next generation to stay engaged with science, and with the scientific publishing process. It's been extremely successful. Assistant editors are part of our team for a two year term. So, in 2020, we will be selecting the next class of assistant editors, and after their term is ended, they join our editorial board as editorial board members. So, we're really excited about that, it's been an overall positive experience, for I think everybody involved. The second thing that we're really excited about is that we launched a social media presence for the journal, which it previously did not have. So, we have a very active Circulation Cardiovascular Interventions Twitter handle, I encourage all the listeners to join Twitter if you're not on Twitter, and if you are on Twitter please follow at Cirque intervened. It's " at C.I.R.C.I.N.T.V.". That is the official Twitter handle for our journal. Dave Fishman is our social media editor, and Chadi Alraies is our assistant social media editor, and we're not just tweeting out the articles, and providing summaries when the papers get published, we're holding Twitter journal clubs once a month ,and these have been extremely successful, it's an hour long Twitter journal club where the discussion gets very intense, and there's a lot of back and forth. We try to have the authors on as well, so that they can explain the rationale for their study, some of the challenges that they face when they are doing the study, and hopefully provide some implications for clinical practice, and what the next steps are. That's a way for us to engage our readership, it's almost a form of post publication peer review, which I think is becoming very popular. In addition, remember we don't have a print format of our journals, so this is a way to get the readership more engaged with the Web site, and to come to our website and learn what elsewhere publishing, and how they can get involve with the Journal as well, both as authors who submit their work, or if they want a peer review for us, please contact us and let us know. Dr Amit Khera: I really love hearing about the Twitter journal club, I know that they are well received, and certainly getting a lot of traction. Tell us about what initiatives or topics you're most excited about this year, and maybe some things that are coming later in the year. Dr Sunil Rao: We're really excited about the big areas in interventional cardiology, which are coronary physiology, we've published quite a few papers on looking at different physiological parameters, and how they can drive the appropriate use of PCI and how that affects outcomes. I think that's going to continue to be a huge topic over the next year, Certainly such a heart disease has exploded, and with the data on low risk patients undergoing TAVR, and having really good outcomes, we're seeing a lot more submissions in the low risk TAVR space, the other area that's really exploding right now is Mitral and Tricuspid Valve Interventions, one of the areas that I think has seen a tremendous amount of device innovation. So, we're seeing a lot of submissions from really high quality papers in that space, but I think it's also important to note, that unlike previous iterations of the Journal, we're actually having a review article, we're trying to have a review article every month on a major area that is burgeoning, so that the readership can understand the overall lay of the land, with respect to evidence, how that guy's clinical practice, and what's coming next. So, we've published quite a few review articles already, and there are more to come, and I think that's a really important way for the readership to keep current with what's going on in Interventional Cardiology. Dr Amit Khera: What about the advancing aspects of your subspecialty? There's so much going on in interventional cardiology, it's a bit dizzying, just tell us a little bit about some of the ways that your journal's helping advance that mission, not just now but perhaps in the future. Dr Sunil Rao: I think one of the challenges that we have at Interventional Cardiology, and maybe this is true across Cardiology, is that the evidence is developed very rapidly, and oftentimes it almost seems like the field is lurching back and forth in certain areas, a prime example of that is the drug coated balloon controversy for Peripheral Interventions. The Journal Of The American Heart Association published a meta-analysis, showing that there may be an association between the use of these devices and increased mortality, that has led to a lot of discussion in the interventional community, and quite frankly I think there's a fair amount of confusion out there about whether we should be using these devices, should we put a moratorium on these devices, is the signal real, if it is, what's the mechanism of death. So, a lot of conversation around that, in fact, it's led to what's going to be a focused FDA meeting in June, specifically on the drug coated balloon controversy. Where I see our journal playing a role is really in trying to, not only publish the latest science, which is rigorous in the field for controversial topics such as this, but also to help provide some context for that science, and I think our integrated strategy of original science review articles, and social media really helps us to communicate with the readership, and with the Interventional Cardiology community writ large, meaning not just physicians, but also Cath lab staff, nurses, noninvasive cardiologists who obviously have patients who are undergoing interventions, and even policymakers, to keep them abreast of what's going on, so that they can have the same level or base of knowledge, so that the conversation is on a level playing field. Dr Amit Khera: Okay, well you heard it from Dr Sunil Rao. Thank you for your time. Dr Kiran Musunuru: I'm Kiran Musunuru, I'm the outgoing Editor-in-Chief of Circulation Genomic and Precision Medicine. Let me start by saying a little bit about the content of the journal, it considers all types of articles related to, as the name implies, Genomic and Precision Medicine, and more specifically, Clinical Genetics, the molecular basis of complex cardiovascular disorders, considered at a variety of levels, that can include a lot of different, what we would call Omics Techniques, from Genomics to Transcriptomics, Proteomics, Metabolomics, Metagenomics, and, so forth. It also deals with big data applications, that includes Electronic Health Record Data, Patient generated data combined with any of the things I've already mentioned, Genome Wide Association Studies, Pharmacogenomics, Gene Therapy, Therapeutic Gene Editing, Systems Biology. So, it's a pretty comprehensive look at all the various topics that would fall under the rubric of Genomic and Precision Medicine. Dr Amit Khera: Now, Dr Musunuru, you mentioned the outgoing Editor-in-Chief, let's introduce the incoming Editor-in-Chief, Thatcher Christopherson Semsarian. Dr Chris Semsarian: I'm the incoming Editor-in-Chief. My name is Chris Semsarian, I'm a cardiologist at the Royal Prince Alfred Hospital in Sydney, Australia. Dr Amit Khera: What are some of the innovations you and the Journal are doing this year, or, what are some of the things you see coming in the future? Dr Kiran Musunuru: Something I'm very excited about, is that we are just starting a pilot project with the American Heart Association's Institute for Precision Cardiovascular Medicine. The institute has a very nice platform called the Precision Medicine platform, and, in brainstorming last year, we realized there was a very nice opportunity to try to create a new type of journal article. There's also a big move in science nowadays to improve transparency, and rigor, and reproducibility, especially in science. The idea being that ideally other investigators should be able to take one team's work, and be able to run through the entire analytical process, and reproduce the original findings, and perhaps even find ways to improve upon those original findings, and, so we realized working with the institute's Precision Medicine Platform, we had the opportunity to actually make a new type of article, we think of, as the paper of tomorrow, a virtual article. The idea would be, that we would have primary data on the Precision Medicine Platform, the analytical tools used to process the data would also be on the Precision Medicine Platform, the analytical plan, in the form of a so-called Jupiter notebook, that basically takes people step by step through exactly which tools were used in which order, in which way, with which parameters, would be on the Precision Medicine Platform, and then there would be some verbal explanation, some background, to explain the context of these analysis, and to really put it into perspective, as how it fits into the body of literature, and so the idea would be, this would live on the Precision Map Platform in a virtual format, and then anyone else who is interested in this work could come, and actually directly interact with the data, and the tools, and the analytical plan, and could actually rerun the entire papers work from scratch, thus reproducing it, and then could actually tweak the analytical plan, or install tools of their own, and be able to build upon the work that had already been done. It's a very different way of thinking about journal articles, more as living entities rather than static work that just lives on a page, and is there as reported, and then never has an opportunity to be fully produced or improved upon. Dr Amit Khera: There's so much happening in the space of genomics, and obviously, we hear the word "Precision Medicine" so commonly. Tell us a bit about how your journal in specific is advancing the mission of your area. Dr Kiran Musunuru: I'll say a little bit, and then maybe turn it over to Chris, give his perspective as the incoming Editor-in-Chief. I think it's a vibrant field, but it's also a very new field, it's evolving rapidly, and I think the Journal has a very important role to play, and not only reporting the results that are coming out of studies in this field, but actually having a role to play in helping to shape the field, helping to define the field, it's very exciting, it's very much in rapid evolution. Just ten years ago or so, when the Journal first started, we were just starting to see the first Genome Wide Association studies, and now we've gone so far beyond that. Now, again, we're talking about these large bio banks, we're talking about Precision Medicine, we're talking about applying this information in health care, we're talking about combining all of these various streams of data and many levels to be able to do studies, that are, I would even say, exponentially advanced beyond what we able to do just ten years ago, and so, it's very exciting times for the journal, then maybe I can ask Chris to share his thoughts on that. Dr Chris Semsarian: Yeah Kiran, I mean, it's a great honor system to follow in your amazing footsteps, and what you've done for the Journal, and as the incoming Editor-in-Chief, I really want to sort of try, and build on the platform that you've established over the last few years, and really, one of the areas that I'm particularly interested in is the area of Translation of Genomic Findings. I mean, ultimately what we do in our lives, as clinicians, is to help patients improve diagnosis, to improve the treatment of these patients, and to be able to do studies with very basic understanding of how our genomes work, and how Narcotic Genes interact, and translating those findings into these improved diagnostic approaches, and even in guiding management is really exciting, I think, in terms of clinical medicine, and improving patient care as we look ahead. I really want to be able to continue to publish really, state of the art, novel, innovative, research areas, that you've already covered, Kiran, which would lead to better care of our patients, who are ultimately the beneficiaries of this type of amazing work. So, I'm really excited looking at the Journal, it's a tremendous area of interest and research, where there's twenty-two thousand genes approximately now genomes, and we really don't understand most of them in terms of their intricate function, and I figured it's a great time ahead, in terms of Precision Medicine. Dr Amit Khera: Okay, well, that was Dr Kiran Musunuru, and Christopher Semsarian, we appreciate both of your time today for Circulation on the Run. Dr Paul Wang: I'm Dr Paul Wang, I'm the Editor-in-Chief of Circulation Arrhythmia and Electrophysiology. Our Journal covers really the expanse of our field, going from basic mechanisms of arrhythmias, so very basic science work, to really clinical practice, clinical outcomes, to population based studies, and genetic based considerations in our field. So, we really feel we encompass the entire range, and there really isn't any topic within our area, that we don't feel is outside our realm. Dr Amit Khera: I know there's so many innovative things you're doing, Dr Wang, with your journal. Why don't you tell us a little bit about your plans for this year. Dr Paul Wang: We've been excited; our team has been at the Journal for two years now, and we focused on a number of different areas. So, I think one of our biggest advances, and we've tried to be more responsive to the authors, so we've really reduced the time to first decision very substantially, from over twenty days, to ten days or less, I think we hit a record of 7.8 days in the journal. So, really, we hope we're more responsive, we've involved the editorial board, we've substantially expanded it, so that more of our reviews of greater proportion going to our editorial board, which is a really fabulous, internationally recognized group, with really high quality reviews, so we've been very pleased, with both a level of science that we've received, as well as the level of the reviews that we have. One other area is, we really want to make sure that the reviewers, who do much of the heavy lifting, in addition to our editors for The Journal, and so we've established a new Reviewer Recognition Award System, they can be designated as silver, gold or platinum, and we've reached out to department chairs, or their deans, and recognizing that they won this prestigious award for their performance, and great work with the Journal, so there are a number of different things that, in fact, we think we've made some advances in, the other areas are really that of extending our reach, and so, one of the things we concentrated on, initially with the adding of podcasts, so we do that monthly. All the articles are now available in review, and then what we're starting at our new initiatives is, we'll be starting a Twitter Journal Club. I've been recording at least two of our articles, as the interview with the authors, and then we're going to be having a journal club, in which we will have the opportunity for people around the world to comment, and have a discussion that will really be exciting, we think. So, there are a number of other areas that we're thinking about, in terms of that kind of work. Dr Amit Khera: The field of Electrophysiology seems to be changing by the day, maybe you can tell us a little bit, about how the journal is advancing the mission of the field of electrophysiology. Dr Paul Wang: So, one of the things that we focused on is the role the Journal can play, in terms of connecting with other elements of our field, and one of the ways that we've really concentrated on is, in particular, working closely with the American Heart Association, and its committees. We're related to a number of committees, but particularly, there is a committee on Electrocardiography, Electrophysiology, part of the Clinical Cardiology Council, and so, we work very closely with that group, and, in fact, we've invited that group to create proposals for a number of review articles, state-of-the-art reviews, that we hope will come out in the next year or so. The ways in which we can tie together our committees to AHA overall, I think, is really the direction we're looking for our journal, and we feel we can play a very novel, and innovative role in that regard. We, for example, also reached out to the American Heart Association funded researchers in our area, and invited them to participate in the journal, participate in our committees, become fellows or FAHA's of the American Heart Association, so we really want to create this family, a real community, and sense of community, that we hope will stem from the Journal. So, we're very excited about the future, and what we might be able to achieve together. Dr Amit Khera: Thank you so much, Dr Paul Wang for your time today, and we appreciate your insights on Circulation, Arrhythmia and Electrophysiology. Dr Nancy Sweitzer: Hi, I'm Nancy Sweitzer. I'm the Editor-in-Chief of the Journal Circulation Heart Failure. At Circ Heart Failure, we deal with all things related to heart failure. Heart failure is an expanding specialty, relatively new subspecialty in cardiology, and we're very interested in the physiology, and mechanisms of heart failure, as well as treatments of heart failure, and the innovative evolution of the specialty which includes Advanced Hemodynamics, Mechanical Circulatory Support, and transplant as therapies, as well as all Implanted Device Therapies, and new, and Innovative Pharmacologic, and Gene Therapies as well. Dr Amit Khera: Tell us a bit about initiatives, or features in Circulation Heart Failure, that you're planning on tackling not only this year, but into the future. Dr Nancy Sweitzer: The effort we're most excited about at Circulation Heart Failure has been ongoing now for a little over a year, but continues, and is really focused on the emerging scientists in the Heart Failure Space; we call it our "Featured Emerging Investigator Spotlight", and this spotlight focuses on authors of manuscripts, who are within ten years of their terminal training, and can take full responsibility for the content of a manuscript. When we publish a featured emerging investigator article, which we've done more than half of the months since launching the feature in late 2017, we schedule a Twitter Journal Club with that author, where we participate, over the course of several hours, in pretty intensive conversation, about not only the science, but career development in Heart Failure Space, the importance of mentoring, and sponsorship obstacles that people are facing in development as physician scientists or scientists, and insights they may have into fostering success in the Heart Failure Space. This has been a great feature, we launched it because we feel that the emerging scientists, in the Heart Failure Space, need a virtual community in those critical years, before you have a lot of resources to start traveling, and setting up a network that's based on personal interaction, and we felt that, the modern era of social media was perfect for this. We found our emerging investigators are getting to know one another, they participate in one another's Journal Clubs, the Journal Clubs are incredibly fun, and interactive and we're getting a lot of Twitter engagement from the Heart Failure Community, there's a lot of "Twitteratti" in Heart Failure that really are engaged, and engaged with the Journal, which has really been fun for all of us, I think, so that's the thing we're most excited about. Dr Amit Khera: It's really wonderful to hear how you're spotlighting authors in creative ways. Tell us a bit about how your journal is advancing the mission of Heart Failure and Transplantation. Dr Nancy Sweitzer: I see the journal as central to advancement of the subspecialty, as I mentioned earlier, Heart Failure is a relatively young subspecialty in the United States, we received a CGMC designation as a subspecialty just in 2008, just eleven years ago, and it's been a board certifiable subspecialty only since 2014. So, we're very young, and I think really developing into our own. We've seen tremendous growth in the number of people seeking subspecialty training in Advanced Heart Failure and Transplant Cardiology, and we are really enjoying helping the Journal evolve with the specialty, as it evolves, and that's happening very actively right now. So, I think what Heart Failure is in 2019 is different than what it was just five years ago in 2014. We're doing a lot more ,as I mentioned, Complex Chemo Dynamic Thinking, thinking about the path of physiology in our patients, and how we can target that effectively, not only with existing therapies, but with strategies, and, as I mentioned, the burgeoning growth of Mechanical Circulatory Support, and support devices, which the field has embraced quite actively, and The Journal is increasingly publishing content in these spaces, as well as the spaces of Advanced Heart Failure, but, I guess also, we're interested in every aspect of Heart Failure, from Complex Multidisciplinary Care Management, to Palliative Care, to the interaction of the heart with other organ systems, and Heart Failure such as the brain, we have a paper on Cognitive Function Abnormalities, and Heart Failure in this month's issue. So, the interaction with the brain, the kidney, the liver, many other organs, that are affected when the heart becomes quite ill with Advanced Heart Disease. So, basically we're interested in everything that touches Heart Failure Development Care, and treatment of patients with Heart Failure, and particularly we're interested in the newest and latest. We love publishing, and some of our highest impact papers in the last couple years have been new therapies, just being tested for the first time in patients with heart failure. Small studies that may not have large impact in terms of heart outcomes, but where we're learning about the pathophysiology of the disease, and new treatments, that's really exciting to us. We've published a couple of methods papers in the last year, really innovative models. One describing a model of pacing in mice, which has been a really challenging thing to do in Heart Failure, but several groups have now developed Tachycardia induced Cardiomyopathy models in mice, which is important for rapid discovery work, because mice have such a short reproductive span, and can be genetically altered, and then a recent publication on the methods paper, looking at a new initiative by the FDA, to potentially approve therapies based on patient reported outcomes, rather than just heart mortality and morbidity outcomes, so we're really excited about the innovations, and the Heart Failure Space, the work that describes where we're going as a field and as a profession. You'll see some features coming up in the journal, from opinion leaders across the globe on where this specialty sits in 2019, and where we, as the leaders in the field, can guide it as we move into our next decade, and I think that some of the most exciting work the journals doing. Dr Amit Khera: Thank you, Dr Sweitzer. We really appreciate your time today for the podcast, and your insights on the Journal. Dr Robert Gropler: Good afternoon, I'm Rob Gropler. I'm the Editor-in-Chief of Circulation Cardiovascular Imaging. It's one of the journals within the family of Circulation Journals, and our focus is really on being the most influential source of leading edge imaging sciences, as it relates to transforming cardiovascular care, so what that means is, that we're interested in all imaging studies that are applied to the care of the cardiovascular patient, and although our primary focus is really on clinicians, and researchers, but we also want to expand our viewership, if you will, to anyone who is interested in how imaging is used to understand Cardiovascular Medicine, and to treat patients with Cardiovascular Disease. So, we are edged in all forms of imaging, this can be from MR, to echo, to nuclear, to CPT, to optical imaging, it involves all types of disease, ranging from Congenital Heart Disease, up to diseases in the elderly, it also involves not just it is in humans, but also understanding disease in the preclinical space, particularly as it helps us understand new technologies that may ultimately reach human use, either for investigational purposes, or ultimately, to be used in the treatment of a patient with Cardiovascular Disease. Dr Amit Khera: What are some innovative things you and the Journal are planning for this year? Dr Robert Gropler: We're doing quite a few things. One of the first things we did, as you know, were relatively new, where we've only been an editorial team, if you will, for one year. One of the major efforts has been to increase our presence, in terms of digital media strategies, across the board. And so, this meant expand our Twitter presence, if you will. It also meant increasing our offerings in that digital space by, for example, having a journal club, what we would do is on a every other month basis, discuss a paper we published that's of significant interest via Twitter. And it would involve the authors, the associate editors who actually manage that study, as well as the editorialist who wrote about that study, and it leads to very unique insights into how that paper is being viewed by the scientific community at large, and also potentially how that information will be implemented in terms of transforming clinical care. We've added what we call a teaching file. If you think about imagers, imagers learn by seeing images. And the more they can see images, put them in the context of clinical cases, the more they understand what an image means when they see it. So, what we do now is we accept a large number of what we call imaging cases. These are specific unique cases that have a history, and then a short write up about them. And those are gathered each month, but then they're downloaded into a file. And then, anyone with access to the Journal can then look at, use to learn from, to potentially use for talks to enhance their own education the education of others. And we have found that to be, again, another offering that our readers particularly like. Dr Amit Khera: And how do you see Circulation Cardiovascular Imaging advancing the mission of imaging, which seems to be ever-expanding, and ever-growing? Dr Robert Gropler: We're really in the education business. And what that means is that we're educating at a multi-scale level. Just educating a practitioner on what technology can do, how it's helping cardiovascular medicine, yes, that's important. But what we're also doing, is we're educating the scientists as to here as some of the new findings that were coming out because of imaging. And then that, in turn, will help direct them or signal them as to where is the science leading them, and what should be their next steps? We're also educating the general public as to what can imaging do, and how does imaging change cardiovascular medicine for the better, and what they can expect from that. And we're also educating the regulatory bodies, if you will, that determine what imaging can be done in the clinical environment and so on, and the importance of these imaging techniques. So number one, I think we always have to maintain that focus, as to that's our goal. Now, that being said, I think the question becomes how do you convey that concept? And where we have to continually evolve. And I think they were very smart years ago to make it a digital-only journal, as opposed to combined print and digital. So, I think that was actually very savvy. But the digital net component now has to expand. And that means our offerings have to reflect not just that people learn in different ways, that is, we have to have not just, if you will, a didactic or print equivalent component of a paper. But it also should be audio-based, such as this podcast. But they also need to be varied as in terms of the types of offerings, and their brevity or length, if you will. Dr Amit Khera: Thank you, Dr Robert Gropler, the Editor-in-Chief of Circulation Imaging. We really appreciate your time today. Dr Robert Gropler: Thank you very much. You have a great day. Dr Amit Khera: Well, I'm sure you enjoyed this as I did. We really got incredible insight from the Editors-in-Chief of our Circulation family of journals. We learned so much about the broad array of subspecialties that they cover, and all the exciting and innovative things they're doing to really advance the missions of their fields, and also for the authors and for science. Well, again, I'm Amit Khera, associate editor from UT Southwestern, Digital Strategies editor for Circulation. And next week, you'll have your usual hosts, Carolyn Lam and Greg Hundley. Dr Carolyn Lam: This program is copyright American Heart Association 2019.
Fifty years ago, cutting-edge science intersected with human drama and changed the course of medical history. The Medical College of Virginia in Richmond was situated squarely in the path of the race to the first successful human heart transplant. And now, it’s history. On March 14, 2018, at the Virginia Museum of History & Culture, a panel of VCU Health transplant surgeons discussed Donald McRae’s book, "Every Second Counts", which details the critical role that the late Dr. Richard Lower and the Medical College of Virginia played in the events leading up to the first human heart transplant in December 1967 and the first human heart transplant by Dr. Lower at MCV in May 1968. The panel highlighted innovations in human organ transplantation during the past 50 years. INTRODUCTORY REMARKS: Charles F. Bryan, Jr., Ph.D. — President & CEO Emeritus, Virginia Historical Society; member of MCV Foundation Board of Trustees MODERATOR: Peter F. Buckley, M.D. — Dean, VCU School of Medicine; Executive Vice President for Medical Affairs, VCU Health PANEL MEMBERS: Vigneshwar Kasirajan, M.D. — Stuart McGuire Professor and Department Chair, VCU Department of Surgery, VCU School of Medicine Marlon F. Levy, M.D. — David M. Hume Endowed Chair in Surgery, VCU School of Medicine; Professor and Chair, Division of Transplant Surgery; Director, Hume-Lee Transplant Center Keyur Shah, M.D. — Section Chief of Heart Failure, Medical Director of Mechanical Circulatory Support, Associate Professor, Division of Cardiology, VCU School of Medicine Daniel G. Tang, M.D. — Richard R. Lower, M.D. Professor of Cardiovascular Surgery, Associate Professor of Surgery, VCU School of Medicine; Surgical Director, Cardiac Transplant and Mechanical Support This lecture was made possible by a generous grant from Virginia Sargeant Reynolds Foundation.
Comfortable with G-tubes, tracheostomies, and VP shunts? Good. Get ready for the next level: Vagus Nerve Stimulators, Intrathecal Pumps, and Ventricular Assist Devices. Details in Audio: Vagus Nerve Stimulators For intractable epilepsy; sends retrograde signal up corona radiata Also may be used in: depression, bulimia, Alzheimer, narcolepsy, addiction, and others VNS magnets Are VNS safe in MRI? Are VNS safe in everyday life? Intrathecal Pumps Used to infuse basal rate of drug, usually baclofen for spasticity, but pump may contain morphine, bupivicaine, clonidine. Also used for severe MS, stroke, TBI, chronic pain. Verify the medication and identify the toxidrome if symptomatic. Ventricular Assist Devices May be left ventricular assist, right ventricular assist, or biventricular assist device. References Vagus Nerve Stimulators (VNS) Elliott RE, Rodgers SD, Bassani L et al. Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases. J Neurosurg Pediatrics. 2011; 7:491-500. Groves DA, Brown VJ. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neuroscience and Biobehavioral Reviews. 2005; 29: 493–500. Panebianco M, Rigby A,Weston J,Marson AG. Vagus nerve stimulation for partial seizures. Cochrane Database of Systematic Reviews. 2015; 4, Art. No.: CD002896. Ruffoli R, Giorgi FS, Pizzanelli C et al. The chemical neuroanatomy of vagus nerve stimulation. Journal of Chemical Neuroanatomy; 2011; 42: 288–296. Intrathecal Pumps Borowski A, Littleton AG, Borkhuu B et al. Complications of Intrathecal Baclofen Pump Therapy in Pediatric Patients. J Pediatr Orthop. 2010; 30:76–81. Ghosh D, Mainali G, Khera J, Luciano M. Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center. Pediatr Neurosurg. 2013; 49:138–144. Yang TF, Wang JC, Chiu JW et al. Ultrasound-guided refilling of an intrathecal baclofen pump—a case report. Childs Nerv Syst. 2013; 29:347–349. Yeh RN, Nypaver MM, Deegan TJ, Ayyangar R. Baclofen Toxicity in an 8-year-old with an Intrathecal Baclofen Pump. J Emerg Med. 2004; 26(4): 163–167. Ventricular Assist Devices Blume ED, Naftel DC, Bastardi HJ et al. for the Pediatric Heart Transplant Study Investigators. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. Circulation. 2006; 113: 2313-2319. Colón JE, Laborde ME, Nossaman BD. Case Report: Left Ventricular Assist Device in a 12 Year Old Child as a Bridge to Heart Transplantation. Section of Congenital Cardiac Anesthesia, Ochsner Medical Center, New Orleans, Louisiana. 2012. Fan Y, Weng YG, Huebler M et al. Predictors of In-Hospital Mortality in Children After Long-Term Ventricular Assist Device Insertion. J Amer Coll Cardiol. 2011; 58(11):1183–90 Fraser CD, Jaquiss RDB, Rosenthal DN et al. Prospective Trial of a Pediatric Ventricular Assist Device. N Engl J Med. 2012;367:532-41. Gazit AZ, Gandhi SK, Canter CC. Mechanical Circulatory Support of the Critically Ill Child Awaiting Heart Transplantation. Current Cardiology Reviews. 2010; 6: 46-53. VanderPluym CJ, Fynn-Thompson F, Blume ED. Ventricular Assist Devices in Children Progress With an Orphan Device Application. Circulation. 2014;129:1530-1537. This post and podcast are dedicated to Joe Bellezzo, MD, FACEP and Zack Shinar, MD, FACEP for bringing us all up to speed. Listen to their fantastic ED ECMO podcast here.
Update your management of heart failure (HF) with expert tips from Cardiologist Dr. Eric Adler, Associate Professor of Medicine and Director of Cardiac Transplant and Mechanical Circulatory Support at UC San Diego. We cover how to use BNP, a simple way to examine jugular venous distention, medical therapy for heart failure, the PARADIGM-HF trial, and how to use sacubitril/valsartan (Entresto). Full show notes available at http://thecurbsiders.com/podcast Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 04:25 Rapid fire questions 06:00 Palliative care and heart failure 08:40 Book recommendation 10:20 Advice for teachers and learners 12:27 Clinical case of HF 13:38 Classification and staging of HF 17:07 Discussion of BNP 19:35 How to perform neck vein exam for JVD 21:20 BNP for prognosis 23:00 BNP at hospital discharge 26:36 Factors that affect BNP 27:25 Initial patient counseling 32:35 Exercise in HF 34:00 Additional testing at time of diagnosis 36:28 Initial medical therapy 38:30 Discussion of diuretics and dosing 42:50 Aldosterone antagonists 44:30 PARADIGM-HF and entresto 51:27 Medications to avoid in HF 54:14 Digoxin 57:30 Dr. Adler’s take home points 59:11 Stuart questions dosing conventions 60:48 Outro Tags: arni, assistant, care, diuretics, doctor, education, failure, family, foam, foamed, health, heart, hospitalist, hospital, internal, internist, neprilysin, nurse, management, medicine, medical, physician, practitioner, primary, resident, sacubitril, student
Welcome back to MCCP! To kick things off we welcome in Dr. Michael Mazzeffi, Associate Professor of Anesthesia at the UMMC, where he additionally acts as the Director for Resident Research Education and Adult Cardiothoracic Fellowship Program Director. He has fast become one of the foremost experts in the field of mechanical circulatory support, publishing numerous papers on the topic. Additionally, his academic prowess has yielded invitations to speak at many prestigious locations around the world. Dr. Mazzeffi was recently a key speaker at the 2016 International Anesthesia Research Society and today he has graciously offered to give us the talk that was the talk of the symposium!
Help Ian interview all 120+ specialties by referring him to more physicians! Show notes! Dr. Zacharias, DO, is an Assistant Professor of Medicine at University Hospitals Cleveland Medical Center in the Division of Cardiology and Section of Heart Failure and Heart Transplantation. He is also currently the Medical Director of the Mechanical Circulatory Support program. Dr. Zacharias completed his undergraduate degree at John Carroll University in 2003; completed his medical degree at the Ohio University Heritage College of Osteopathic Medicine in 2007; completed an Internal Medicine residency, followed by a Cardiology fellowship both at the University of Massachusetts Memorial Medical Center by 2014 where he also served as a Chief Resident and as a Chief Cardiology Fellow. He then completed a fellowship in Advanced Heart Failure and Cardiac Transplantation at the University of Wisconsin Hospital and Clinics in 2015 before returning to Ohio to join the faculty at Cleveland Medical Center where he remains today. Dr. Zacharias’ clinical interests include invasive hemodynamics, temporary and durable mechanical circulatory support, and cardiac transplantation. He sees himself as a clinician educator and mentors local students interested in pursuing a career in medicine. At the completion of medical school he was a finalist for the Dean’s Award and at the completion of his Chief Resident year he was the recipient of the University of Massachusetts Department of Medicine Recognition Award for extraordinary contributions to medical education. Please enjoy with Dr. Michael Zacharias!
In this episode we explore two very different applications of the Impella® device - a percutaneously-placed temporary ventricular assist device (VAD) sold by Abiomed (no financial disclosures). These VADs work by the use of a micro-axillary pump which is typically placed by interventional cardiologists under fluoroscopy. The inlet of the pump is placed in the ventrical while the outlet rests just above the aortic valve. The post EDECMO 32 – Archimedes Screw: Is Impella the Future of Mechanical Circulatory Support? appeared first on ED ECMO.
In this episode of the Heart podcast, Digital Media Editor Dr. James Rudd is joined by Dr Divaka Perera from St. Thomas' Hospital, London. Divaka recently published an Education in Heart paper entitled "Percutaneous mechanical circulatory support: current concepts and future directions" - http://heart.bmj.com/content/early/2016/08/08/heartjnl-2015-308562.extract They discuss the physiology behind these devices, when they might be used, and the difficulty in producing robust guidelines in this area of cardiology.
Louisville Lectures Internal Medicine Lecture Series Podcast
In this lecture, Dr. Lorrel Brown takes time to discuss the indications, mechanics, and physiology of mechanical circulatory support. She provides a great introduction for internists to some of the most advanced ICU therapies. Dr. Lorrel Brown covers evidence and indications for various modalities like IABP (intra-aortic balloon pump), ECMO (extracorporeal membrane oxygenation), and percutaneous VAD (ventricular assist device). Some items in this lecture may have come from the lecturer’s personal academic files or have been cited in-line or at the end of the lecture. For more information, see our citation page. Disclaimers©2016 LouisvilleLectures.org
Regenerative Medicine Today welcomes Richard Schaub, PhD. Dr. Schaub is the Senior Director of the Artificial Heart Program at UPMC and the Senior Director of Mechanical Circulatory Support at Procirca. Dr. Schaub discusses his work with the Artificial Heart Program. For more information about the Artificial Heart Program, click here. For more information [...]
Audio Commentary by Dr. Valentin Fuster
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