Podcasts about mitraclip

Dr. Jordan B. Peterson sits down for a candid discussion with Dr. Mehmet Oz, discussing the toxified food environment within the United States—pointing directly to its causes—and exploring not just possible, but immediate routes for change. These include better governmental oversight, but also the implementation of new technologies such as AI. Dr. Mehmet Oz, newly appointed by President Donald Trump as the 17th Administrator of the Centers for Medicare and Medicaid Services (CMS), is a cardiothoracic surgeon, professor emeritus at Columbia University, and former leader of the heart institute at New York Presbyterian Medical Center, known for innovations like the Mitraclip and over 400 publications in heart surgery, health policy, and complementary medicine. He gained national fame through The Dr. Oz Show, winning nine Daytime Emmys and authoring several New York Times bestsellers, before becoming the 2022 Republican nominee for U.S. Senate in Pennsylvania. A Harvard and UPenn MD/MBA graduate, Oz also co-founded the influential health platform Sharecare and the nationwide teen wellness initiative Healthcorps. His public influence has been recognized by Time, Forbes, and Esquire, making him a high-profile figure at the intersection of medicine, media, and policy. This episode was filmed on November 13th, 2024  | Links | For Dr. Mehmet Oz: On X https://x.com/droz?lang=en On Instagram https://www.instagram.com/dr_oz/?hl=en Dr. Mehmet Oz shares his vision for CMS https://www.cms.gov/newsroom/press-releases/dr-mehmet-oz-shares-vision-cms   

Insuficiência mitral na IC: quando o MitraClip faz a diferença? by Cardiopapers

Mamas Mamas, Stefan Anker, and Volker Rudolph talk about their studies of MitraClip for functional MR in patients with heart failure.

Anita W. Asgar, MD, recently named section head of Interventional Cardiology at Northwestern Medicine, introduces herself and reveals what drew her to join the team at Northwestern Medicine Bluhm Cardiovascular Institute. Dr. Asgar shares her goals for the future of the Interventional Cardiology program, her clinical and research interests in structural heart interventions and moderate secondary mitral regurgitation, and her experience working on MitraClip procedures in Canada.

In the December 2024 issue of JACC, Dr. Valentin Fuster summarizes five pivotal clinical studies, including one on bleeding and mortality following revascularization for left main coronary artery disease, which highlights higher bleeding rates post-CABG compared to PCI. Other key articles explore the use of the MitraClip in treating moderate-to-severe functional mitral regurgitation, evaluating its impact on hospitalization and quality of life, as well as comparing aspirin monotherapy to no antiplatelet therapy in patients undergoing low-risk non-cardiac surgery, and testing a novel low-dose triple pill for hypertension.

This week on The Beat, CTSNet Editor in Chief Joel Dunning speaks with EACTS Secretary General Patrick Myers about the highlights of the upcoming 38th EACTS Annual Meeting. They discuss what speakers they are looking forward to hearing from and the compelling topics that will be covered. They also share information about EACTS TV and hints and tips for those attending the meeting.    Joel also reviews recent JANS articles on mitral leaflet shortening as an ancillary procedure in obstructive hypertrophic cardiomyopathy and priorities and strategy for the implementation of enhanced recovery after surgery (ERAS) in thoracic surgery.   In addition, Joel explores a Yacoub II valve conserving operation for aortic root remodeling, robotic application of an AtriClip, and tricuspid replacement and mitral valve repair after a failed MitraClip to the tricuspid leaflets. Before closing, he shares upcoming events in CT surgery.   The Beat is taking a quick break and will return with a new episode on October 18, 2024.   JANS Items Mentioned  1.) Mitral Leaflet Shortening as an Ancillary Procedure in Obstructive Hypertrophic Cardiomyopathy  2.) Priorities and Strategy for the Implementation of Enhanced Recovery After Surgery (ERAS) in Thoracic Surgery  CTSNET Content Mentioned  1.) Yacoub II Valve Conserving Operation for Aortic Root Remodeling  2.) Robotic Application of an AtriClip for Chronic Atrial Fibrillation  3.) Tricuspid Replacement and Mitral Valve Repair After a Failed MitraClip to the Tricuspid Leaflets  Other Items Mentioned  CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

No Click Valvar de hoje temos grandes insights sobre a discussão do MitraClip na Regurgitação Mitral funcional.

Σε αυτο το επεισόδιο, συζητάμε με τις μεγάλες μελέτες του ESC 2024 1) Νέο όπλο κατά της HFmrEF-HFpEF, η φινερενόνη (FINEARTS trial) 2) Mitraclip σε δευτεροπαθή MR σε ασθενείς με HFrEF. Δουλεύει ή οχι; 3) Mitraclip vs χειρουργείο σε δευτεροπαθή MR σε ασθενείς με HFrEF. 4) B-blockers μετά από εμφραγμα του μυοκαρδιου με διατηρημένο κλάσμα εξώθησης. To stop or not to stop?

Witam Państwa, nazywam się Jarosław Drożdż, pracuję w Centralnym Szpitalu Klinicznym Uniwersytetu Medycznego w Łodzi, skąd nagrywam podcast Kardio Know-How. W tym odcinku kontynuuję omawianie doniesień z kongresu ESC.Szczegółowy TRANSKRYPT do odcinka.Podcast jest przeznaczony wyłącznie dla osób z profesjonalnym wykształceniem medycznym.

Venous closure devices, GLP1-s linked to blindness and cancer, resisting the urge to do an ECG, and transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation are the topics discussed this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study https://doi.org/10.1093/europace/euae105 II GLP1-s and Blindness Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255 Locke Twitter  https://x.com/doc_BLocke/status/1808972226655629610 When to Start a Statin Is a Preference-Sensitive Decision https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029808 III GLP1-s and Cancer Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820833 IV Screening ECG Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2820721 Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP)  https://doi.org/10.1016/S0140-6736(21)01637-8 Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study) https://doi.org/10.1016/S0140-6736(21)01698-6 IV TEER for Secondary Mitral Regurgitation Randomized investigation of the MitraClip device in heart failure: Design and rationale of the RESHAPE-HF2 trial design https://doi.org/10.1002/ejhf.3247 Percutaneous repair of moderate-to-severe or severe functional mitral regurgitation in patients with symptomatic heart failure: Baseline characteristics of patients in the RESHAPE-HF2 trial and comparison to COAPT and MITRA-FR trials https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.3286 Jun 21, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001237 Stats Blog https://www.r-bloggers.com/2023/07/the-benjamini-hochberg-procedure-fdr-and-p-value-adjusted-explained/ You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

LATE BREAKING CLINICAL TRIAL: Three-Dimension Intracardiac (3D-ICE) vs Transesophageal (TEE) Echocardiography to Guide Transcatheter Edge-to-Edge Repair (TEER) With MitraClip: Interim Results of the 3 Dice-Clip Trial

Three-Dimension Intracardiac (3D-ICE) vs Transesophageal (TEE) Echocardiography to Guide Transcatheter Edge-to-Edge Repair (TEER) With MitraClip

This week we delve into the world of interventional cardiology and the Fontan when we review a recent report from the Children's Hospital of Philadelphia on the use of the "MitraClip" for the treatment of AV valve regurgitation in the congenital heart patient. Who would be a good candidate for this novel approach? What are the steps in planning or consideration of this technique in a congenital heart patient? How durable is this form of repair? These are amongst the many questions reviewed this week with this week's senior author, Professor of Pediatrics at the Children's Hospital of Philadelphia, Dr. Matthew J. Gillespie. DOI: 10.1002/ccd.30935

In this episode of The Saving Lives Podcast, we explore the innovative MitraClip system, a less invasive treatment for mitral regurgitation. The discussion covers the device's evolution, its impact on patient outcomes, and the challenges and complications associated with its use. The Vasopressor & Inotrope Handbook: ⁠⁠⁠⁠⁠Amazon Affiliate Link⁠⁠⁠⁠⁠ (I will earn an extra small commission) and ⁠⁠⁠⁠⁠Signed/Personalized Copies⁠⁠⁠⁠⁠. Citation: Schnitzler K, Hell M, Geyer M, Kreidel F, Münzel T, von Bardeleben RS. Complications Following MitraClip Implantation. Curr Cardiol Rep. 2021 Aug 13;23(9):131. doi: 10.1007/s11886-021-01553-9. PMID: 34387748; PMCID: PMC8363549. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

No Click Valvar de hoje temos grandes insights sobre o MitraClip em pacientes com regurgitação funcional.

No Click Valvar de hoje temos grandes insights sobre o tratamento clínico antes de implantar um MitraClip.

In this special episode of AbbottTalks, recorded live from DeviceTalks West in October 2023, we celebrate a pivotal moment in medical innovation: the 20th anniversary of Abbott's MitraClip™, a revolutionary device introduced in 2003. In the episode, the inventor of the MitraClip, Frederick St. Goar, MD, Interventional Cardiologist, El Camino Health, and Abbott's Santosh Prabhu, PhD, Divisional VP, Global Product Development, discuss the journey of the MitraClip, reflecting on its inception, evolution, and lasting impact on cardiac care over the past two decades. Dr. Goar provides insights into the early challenges and motivations behind inventing the MitraClip, emphasizing its role in transforming minimally invasive cardiac procedures. He reflects on the initial concept, design iterations, and clinical experiences with the device. Dr. Prabhu discusses the continuous enhancements made to the MitraClip since its inception, focusing on improved safety, efficacy, and usability. He highlights the MitraClip's role in reducing hospitalizations and improving patient outcomes, as evidenced by the five-year results from the landmark COAPT™ trial. The episode pays tribute to the legacy of the MitraClip, acknowledging its significant contribution to medical technology and patient care and emphasizing the importance of interdisciplinary collaboration and patient-centric approaches in medical innovation. Thank you to Zeus for sponsoring this episode of AbbottTalks. For more information about Zeus go to www.ZeusInc.com. Thanks for listening to this episode of the AbbottTalks podcast. Please subscribe to the DeviceTalks Podcast Network. COAPT Trial Release -https://abbott.mediaroom.com/2023-03-05-Late-Breaking-Data-from-Landmark-COAPT-TM-Trial-Show-Long-Term-Benefits-of-Abbotts-MitraClip-TM-Device MitraClip History - https://www.abbott.com/corpnewsroom/products-and-innovation/the-mitraclip-story.html#:~:text=MitraClip's%20story%20starts%20in%20California,The%20idea%20was%20unheard%20of.

No Click Valvar de hoje temos grandes insights sobre prolapso da válvula mitral e o Implante de MitraClip.

Welcome to the MassDevice Fast Five medtech news podcast, the show that keeps you up-to-date on the latest breakthroughs in medical technology. Here's what you need to know for today, October 26, 2023. Check out the show notes for links to the stories we discuss today at MassDevice.com/podcast. Abbott this week reported positive data for its MitraClip and TriClip devices. Fast Five hosts Sean Whooley and Danielle Kirsh discuss the most compelling data from the results and what executives think. A Boston Scientific executive is joining the board of directors at Day Zero Diagnostics. Hear who is taking a board seat and why. Fresenius Medical Care has a Class I recall of some hemodialysis systems. Find out which devices are affected and what the company is doing to fix the issue. Ashely McEvoy's departure from Johnson & Johnson means she has to step down from her role as board chair of AdvaMed. Whooley details if the trade organization has chosen a replacement and what AdvaMed CEO Scott Whitaker had to say about her tenure. Medtronic has selected a location to manufacture its renal denervation technology if it is approved by the FDA. The Fast Five hosts discuss the manufacturing location and the reason behind the hold up of getting the technology to market.

CV drug costs, a sexual misconduct survey, incidental CAC on chest CT, real-world MitraClip, and a new cardiology board.

No Click Valvar Academy de hoje temos grandes insights sobre a abordagem cirúrgica convencional após uma falha do MitraClip. Ficou demais!

No Click Valvar de hoje temos grandes insights sobre o remodelamento reverso após o implante do MitraClip. Ficou demais!

Mitral valve regurgitation is a heart valve condition that affects the flow of blood in the heart. In this episode of “Heart to Heart,” we hear from Dr. Katikaneni as he discusses mitral valve regurgitation, leaky valves, prevention tips and alternative treatment options to open heart surgery (such as the MitraClip™ procedure). The post Mitral Valve first appeared on Advanced Cardiovascular Specialists.

No Click Valvar Academy de hoje temos grandes insights sobre a comparação entre dados de Trials e mundo real no uso do MitraClip. Ficou demais!

Mitraclip: 5 anos do COAPT by Cardiopapers

No Click Valvar de hoje temos grandes insights sobre MitraClip na Insuficiência Mitral Funcional.

In this episode we re-air an interview that is both informative and enjoyable to listen to, with Savni Kulkarni, a colleague of mine from Georgia Tech.

Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast is an exciting journey towards improved anesthesia patient safety.Join us today in the cardiac catheterization laboratory as we discuss interventional cardiology procedures including TAVR, MitraClip, transcatheter mitral valve replacement, transesophageal echocardiography, and direct current cardioversion. Tune in to learn more about these procedures, unique complications, and strategies to help keep patients safe.Additional sound effects from: Zapsplat.© 2023, The Anesthesia Patient Safety FoundationFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/132-keeping-patients-safe-during-interventional-cardiology-procedures/

No Click Valvar de hoje temos grandes insights sobre os custos do MitraClip e se vale tanto investir nessa terapia.

Echo Guidance for MitraClip Guest: Jeremy J. Thaden, M.D. (@JeremyThaden) Host: Kyle W. Klarich, M.D. (@KyleWKlarich) Joining us today to discuss echo guidance for the MitraClip is Dr. Jeremy Thaden, M.D., Associate Professor of Medicine and cardiovascular ultrasound expert at Mayo Clinic in Rochester Minnesota.  Specific topics discussed: What are the key parameters for patient selection prior to MitraClip? What do you consider to be the keys to success for procedural guidance? How do you assess procedural success? Residual mitral regurgitation and transvalvular gradient post-procedure? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.  

Kontynuujemy serię zastępstw w prowadzeniu naszego podcastu, a tym razem lek. Oliwia Matuszewska-Brycht porusza temat zabiegów typu MitraClip.Szczegółowy TRANSKRYPT do odcinka.Podcast jest przeznaczony wyłącznie dla osób z profesjonalnym wykształceniem medycznym.

No Click Valvar de hoje temos grandes insights sobre o uso do MitraClip em insuficiência mitral funcional. Está demais!

Functional Mitral Regurgitation in Heart Failure Guest: Grace Lin, M.D. (@Grace_Lin_MD) Host: Paul A. Friedman, M.D. (@drpaulfriedman) Joining us today to discuss Functional Mitral Regurgitation in Heart Failure is Grace Lin, M.D., professor of medicine and vice chair for the division of circulatory failure at Mayo Clinic in Rochester, Minnesota. Specific topics discussed: What is functional mitral regurgitation Why does it occur in heart failure? How do you treat it? Who is eligible for MitraClip? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

The MitraClip™ could be a simple solution to your leaky heart valve. Even better, this procedure can be performed right here in Shreveport. In this episode of “Heart to Heart,” Dr. Katikaneni explains how patients have experienced significant improvement in their quality of life after the MitraClip™ procedure.

No Click Valvar de hoje, temos insights sobre um aspecto interessante, os aspectos clínicos relevantes sobre os critérios de inclusão dos famosos Trials COAPT e Mitra-FR na prática diária!

In this 224th episode I welcome back Drs. Essandoh and Cody to talk about the MitraClip procedure. We review the pathophysiology of mitral regurgitation and then talk about the indications for this endovascular procedure, how it's done and what complications can arise.Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

No Click Valvar de hoje, temos insights sobre um aspecto interessante, os aspectos clínicos relevantes sobre a reoperação mitral após implante de MitraClip!

Mais um Episódio do nosso programa The Valve Club Academy! Nesse Click Valvar, grandes Insights sobre o uso do Ecocardiograma no screening e no intra procedimento de implante de MitraClip! Está demais!

No Click Valvar de hoje, temos insights sobre um aspecto interessante, o dia a dia, o mundo real do uso de MitraClip na Insuficiência Mitral de etiologia Funcional!

Coffee and Cardiology with Interventional Cardiologist Dr. Jamie McCabe to talk about what it takes to complete 150 mitraclip procedures, redefining how outcomes are measured, what leadership means to him and his crossroads between furniture making and medicine.2:57 - Mitraclip5:30 - Structural Heart Team7:05 - Dynamics of multidisciplinary teams9:40 - Volumes (Both sides)16:40 - TAVR Returns19:00 - TAVR Patient Selection 22:10 - Physician Report Cards25:00 - Risk Treatment Paradox29:40 - Leadership philosophy 33:45 - Vision of the Cath lab37:23 - Impact of Covid41:06 - Outside of the Lab42:43 - The furniture maker?49:08 - The pinnacle of structural heartDr. James (Jamie) McCabe grew up in Boston, Massachusetts, graduated magna cum laude from Bowdoin College and received his medical degree from Yale University. He has completed 10 years of post-medical school training including internal medicine training and general cardiology fellowship at University of California, San Francisco (UCSF) and interventional cardiology fellowship as well as an advanced interventional fellowship in structural and peripheral treatments at Brigham and Women's Hospital / Harvard Medical School. He is board certified in Internal Medicine, Cardiology, and Interventional Cardiology.Dr. McCabe joined the University of Washington Medical Center in 2013. He became medical director of the Cardiac Cath Labs in 2015 and subsequently was named Chief of Interventional Cardiology for the UW System in 2020. His clinical practice leverages his knowledge and experience in clinical cardiovascular medicine and complex coronary and valvular heart interventions. Dr. McCabe is an international leader in structural heart interventions including repair or replacement of all heart valves using catheter-based methods. He also treats all forms of coronary artery blockage and cardiogenic shock. He is an internationally recognized clinician educator and investigator in transcatheter therapies for valvular heart disease. His research interests focus on quality and performance metrics for cardiovascular procedures and novel transcatheter therapies to address unmet needs in the structural heart space. He has been the site principal investigator for dozens of clinical trials and has authored more than 100 original manuscripts and multiple book chapters related to his work. He lectures frequently at national and international meetings including at Transcatheter Cardiovascular Therapeutics (TCT), Trancatheter Valve Therapeutics (TVT), American College of Cardiology (ACC) and Society for Cardiac Angiography and Intervention (SCAI), amongst others. He has also been asked to perform live televised procedures for national and international audiences across multiple continents. He has been recognized as an Emerging Leader in Medicine by SCAI and the ACC, named one of three finalists for the Linnemeier Award, and voted a “Top Doc” in cardiology multiple years in a row by Seattle Magazine and Seattle Met Magazine.To reach Dr. Jamie McCabe you can email him at jmmccabe@uw.edu.Or send a referral or consult request here:  https://hipaa.jotform.com/uwheart/referrals

In this episode this successful student, now a specialist at Abbot, discussed her career thus far, and what has helped her achieve her academic success to date. An excellent interview.

| 29 | Intro to ECMO, with Dr. Allison Dupont, FSCAI, FACC In this episode, we were lucky enough to sit down with none other than Interventional Cardiologist, Dr. Allison Dupont.  Dr. Dupont is a board-certified cardiologist in interventional cardiology and cardiovascular disease. She has a clinical interest in cardiogenic shock, minimally invasive structural procedures including MitraClip and Watchman, and in catheterization techniques that help reduce complications in high-risk patients. Dr. Dupont has extensive experience in caring for critical cardiac patients, including being one of the leaders developing the ECMO (Extracorporeal Membrane Oxygenation) for one of the leading cardiac centers in the southeastern United States.  Join us as Dr. Dupont guides us through ECMO and the treatment of patients in cardiogenic shock, and how ECMO and ECPR is paving the way to the future standard of care.  If you like what you hear-  Make sure to download, subscribe, and share with your friends and co-workers.  Find us on all major platforms and podcast providers, as well as our socials! | Facebook | Instagram | Twitter | Linked-In | YouTube | www.medicclasscitizen.com |  MERCHANDISE NOW AVAILABLE! https://www.medicclasscitizen.com/shop 

Mais um Episódio do nosso programa The Valve Club Academy! Nesse Click Valvar, grandes Insights sobre a intervenção transcateter na Insuficiência Tricúspide! Está demais!

Episode 19 features Dr. Mohammad Qintar, an Interventional Cardiologist at the Sparrow Thoracic Cardiovascular Institute, discussing structural heart disease and treatment options available including TAVR, Watchmen, and Mitraclip.

RUSH University Medical Center and the RUSH Center for Congenital Structural Heart Disease have been at the forefront in developing state-of-the-art therapies for congenital and acquired structural disorders. Minimally invasive innovations, such as transaortic valve replacement (TAVR), MitraClip and the CoreValve, have helped patients enjoy faster recovery times, less pain and, typically, less cardiac rehabilitation. Clifford Kavinsky, MD, PhD, joins the podcast to profile the next generation of minimally invasive cardiac care, including several clinical trials that RUSH is participating in. Dr. Kavinsky is the Director of the RUSH Center for Adult Structural Heart Disease, the Chief of the Section of Structural and Interventional Cardiology and the Associate Director for the Cardiovascular Disease Fellowship Program. He is an expert on catheter-based therapies for heart and vascular disease and is an internationally recognized leader in the use of novel treatments for adults with congenital and structural heart disease. “It's a really exciting time to practice cardiovascular medicine when there's such an explosion of technology and thrust towards less invasive techniques that historically we've always done with large surgical procedures. It's particularly satisfying to be able to put a new valve in a patient and send them home the next day.  When you think about surgery and how they used to be in the hospital for a week and recover for six to 12 weeks, it's quite remarkable.” CME link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/483920/    

Returning guest, Dr. Kendra Grubb, surgical director of the Structural Heart and Valve Center at Emory Healthcare in Atlanta discusses Medtronic's announcement of early results from the OPTIMIZE PRO clinical study at the Society for Cardiovascular Angiography & Interventions (SCAI) 2021 Scientific Sessions. The study evaluated procedure-related techniques and care pathways when using the self-expanding, supra-annular Evolut™ PRO and PRO+ TAVR systems in patients with symptomatic severe aortic stenosis. Dr. Kendra Grubb is the surgical director of the Emory Structural Heart and Valve Center. Prior to joining Emory, Dr. Grubb was the director of minimally invasive cardiac surgery and the surgical director of the heart valve program at the University of Louisville. Dr. Grubb is a champion for women's heart disease, and is dedicated to improving the lives of all patients, both male and female, through innovation and by building collaborative teams to promote a patient-centered approach to the treatment of cardiovascular disease.Dr. Grubb has led and participated in multiple clinical trials of innovative cardiac surgery technologies, including studies of transcatheter aortic valve replacement (TAVR), MitraClip percutaneous therapy, and the GORE® conformable TAG® thoracic endoprosthesis for the primary treatment of aneurysms of the descending thoracic aorta.Dr. Grubb attended the University of Southern California, where she received her MD degree from the Keck School of Medicine and her Master of Health Administration from the Sol Price School of Public Policy. She completed her general surgery residency at the University of Illinois at Chicago in 2010, her fellowship in cardiothoracic surgery at the University of Virginia in Charlottesville in 2012, and her fellowship in interventional cardiology and transcatheter therapies at New York Presbyterian/Columbia University Medical Center in 2013. #OPTIMIZEPRO #SCAI #EvolutPRO

Frederick St Goar, MD Dr. Frederick St. Goar is a cardiology specialist, physician inventor, and entrepreneur. He currently serves as vice chairman of the board of the Fogarty Institute in Mountain View, CA. His career was jump-started at Stanford when he joined Paul Yock in working on intravascular ultrasound imaging. Subsequently he became involved in launching Heartport. He invented the minimally invasive MitraClip system, co-founding Evalve. He consults for several established medical device companies and is active in the Stanford Biodesign program as well as the Fogarty Institute. Dr. St. Goar has over 36 years of experience in the field; he graduated from Harvard Medical School and completed a residency at Stanford University Medical Center. He currently practices at Advanced Cardiovascular Specialists and is affiliated with medical facilities such as El Camino Hospital Mountain View Campus and Mills-Peninsula Medical Center.  

Dr. Carolyn Lam:               Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore, and I'm just so thrilled to be joined by a co-host today and that's Dr. Amit Khera. He's the Editor of Digital Strategies for Circulation from UT Southwestern. Welcome, Amit. Dr. Amit Khera:                 Hi, Carolyn. Thank you for letting me participate today and we're excited about this Fit featured podcast. Dr. Carolyn Lam:               We have a very special episode today. First of all, because we don't have a print issue that follows this week and so, there's no usual summaries, but we do have special guests and these are the Fellows-in-Training.                                                 Now, we sent out a call online to all the fellows to tell us a bit about themselves as well as which articles in Circulation stood out to them, and we had an overwhelming response from all over the world, of which these two fellows really stood out.                                                 So, join me in welcoming Dr. Punag Divanji from United States and Dr. Mayooran Namasivayam from Australia. Welcome. Dr. Punag Divanji:            Hi, thank you so much for having us. Dr. Mayooran Namasivayam:      Thank you very much. Dr. Carolyn Lam:               So, Punag, could you start us off by telling us a little bit about yourself, your training, your dreams, and why you chose that particular paper from this month's Circulation that spoke to you? Dr. Punag Divanji:            I'm currently a second year Cardiology Fellow, completing my General Fellowship and beginning a research year at the University of California in San Francisco. I will be pursuing research in women's health and subsequently pursuing an Interventional Cardiology Fellowship. Subsequently, this, hopefully, will lead to a career in academic Interventional Cardiology. Dr. Carolyn Lam:               Now, we asked you to pick an article from Circulation. I really wonder which was your pick? Dr. Punag Divanji:            I think one of the most important ones that spoke to me recently was the CVD-REAL Study, the comparative effectiveness of cardiovascular outcomes in new users of SGLT2 inhibitors. The CVD-REAL Study from Dr. Kosiborod of the Saint Luke's Mid America Heart Institute and an international group of colleagues was the first multinational retrospective observational study to compare CVD outcomes in patients with type 2 diabetes, who were prescribed sodium-glucose co-transporter 2 inhibitors or SGLT2 inhibitors. The primary objective of this study was to compare the risk of hospitalization for heart failure in patients with established type 2 diabetes that were newly initiated on SGLT2 inhibitors.                                                 Patients who were newly initiated on an SGLT2 inhibitor had a 39% lower risk of hospitalization for heart failure compared with those newly initiated on other glucose lowering drugs. There was significant geographic variation in the use of SGLT2 inhibitors, with the predominance of canagliflozin in the United States, dapagliflozin in European countries, and no more than 7% penetration of empagliflozin in any of these six countries.                                                 Despite this, there was no signs of significant heterogeneity across the countries, suggesting the cardiovascular benefits observed may be class related. In addition, the reduced risk of hospitalization for heart failure was stable across sensitivity analyses, including sequential occlusion of other glucose-lowering drugs like insulin, metformin, or even the GLP-1 receptor agonists, the only other class of drug with benefits in CVOTs. Dr. Carolyn Lam:               Punag, give us an idea why this paper stand out to you. I mean, we had the EMPA-REG Outcome Trial, and I'd love to know how much you use this medication in your practice, and did it change after this? Dr. Punag Divanji:            This is, I think, a profoundly important study for a number of reasons. Type 2 diabetes carries a significant burden of cardiovascular risk. It's associated with complications like heart failure, myocardial infarction, and all caused death, of course. We have for many years been treating cardiovascular disease in diabetes with an aim towards reduction in hemoglobin A1c. However, we know that reduction in hemoglobin A1c has not necessarily resulted in improvement in cardiovascular outcomes. The EMPA-REG Outcome Study and the recent CANVAS Study seem to suggest that these medications may have a benefit, these SGLT2 inhibitors may have a benefit in cardiovascular outcomes.                                                 In practicing clinical cardiology, we often refer our patients with diabetes to endocrinologists or to their Primary Care physicians to initiate diabetes medications, and aren't directly involved in that decision making. The result of trials like these though, seems to indicate that medications that can have a cardiovascular outcome in this high-risk patient population, may indeed benefit from the input of cardiologists.                                                 With the high penetrance of medications like insulin and metformin in this population, there may indeed be room for initiation of SGLT2 inhibitors, and if it is indeed a class effect, as this seems to indicate, there is considerable room for addition of this medication into our  [inaudible 00:05:13]. And potentially a pretty significant benefit, in terms of cardiovascular outcomes. Dr. Carolyn Lam:               I agree. I took that with me as well, especially because, you know, it's as the name says, CVD-REAL was supposed to be a real world setting, and it included diabetic patients, like you nicely emphasized that didn't have established cardiovascular disease, so maybe addressing a wider population than that was seen in EMPA-REG Outcomes. Thank you so much, Punag.                                                 Could I turn to you now, Mayooran? So, all the way from Australia, could you tell us a little bit about yourself and your training? Dr. Mayooran Namasivayam:      I'm in my third year of Cardiology Fellowship at St. Vincent's Hospital in Sydney, Australia. I'm also involved with post-graduate research doing my PhD through the University of New South Wales and the Victor Chang Cardiac Research Institute doing clinical work here at St. Vincent's. And my particular areas of interest are cardiac imaging and heart failure, and I'll be looking to do an advance Fellowship in imaging and/or heart failure in the near future. Dr. Carolyn Lam:               Brilliant! So, which paper did you pick over the last month? Which spoke to you? Dr. Mayooran Namasivayam:      I picked two papers. But the first one I was going to discuss was the paper by Nickenig and colleagues, which looked at trans-catheter treatment of severe tricuspid regurgitation using edge-to-edge MitraClip technique, which I found very interesting. So this was an observational feasibility study, which primarily looked at safety outcomes at 30 days, but also the technical feasibility of performing this procedure for tricuspid regurgitation therapy. Essentially the authors demonstrated that there was a reduction in tricuspid regurgitation severity or TR grade in 91% of their cohort. There are also improvement in soft surrogate endpoints such as New York Heart Association class and six-minute walk test distance, and importantly there were no intraprocedural major adverse events; however, there were three in-hospital deaths.                                                 I found the study particularly interesting because it's a very emerging technology using the MitraClip in the tricuspid position and to date, this is the largest study on this subject. It recruited patients from 10 centers. I think, interestingly, the 22 patients in that cohort, had both mitral and tricuspid valve disease treated with the MitraClip technique. I think it really bodes well for the future of transcatheter valve interventions and I think shows that this is A, technically possible, but in the early stages at least safe and possibly efficacious, but certainly we would need longer term data to confirm that this is making a difference for people and that it is safer in the long term. I think it raised a lot of important issues going forward using transcatheter interventions in the tricuspid position. Dr. Carolyn Lam:               You said that you're interested in heart failure and training in heart failure. Do you see that a lot, because I certainly do? Dr. Mayooran Namasivayam:      Yes, we see it quite a lot at our center. Our center is a [inaudible 00:08:10] transplant center and so a lot of our patients with cardiomyopathy have quite bad tricuspid regurgitation. Many of them in the setting of left heart failure, some in the setting of pulmonary hypertension, and then some in our post transplant population we see some tricuspid regurgitation as well.                                                 I think we're following on from the surgical literature, which shows that if you have some degree of mitral regurgitation that requires surgical intervention and there's at least moderate tricuspid regurgitation, then correction of that may be of some benefit. If we follow that on using transcatheter methodology, then certainly this may be an option going forward for patients that have transcatheter mitral valve repairs or replacements. One of the benefits of using a transcatheter method is you're not limited to the one opportunity you have with cardiopulmonary bypass where a decision's made to seek either both mitral and tricuspid together or potentially do it as staged procedure if we were to use the transcatheter approach.                                                 So, yeah, we certainly see severe tricuspid regurgitation a lot and I think options such as this really do give us therapeutic opportunities for our patients who may not have the surgical robustness to have a general anesthetic and a big tricuspid valve replacement or repair surgically. I think the other key population where this may be relevant is tricuspid valve intervention in the post transplant setting where re-operation in the setting of immunosuppression may be problematic and fraught with adverse events. I think it's quite promising going forward and I'd love to see more data on this in the near future. Dr. Carolyn Lam:               Indeed, and it's just so nice to hear about how the articles in our journal have, well, if I may say, inspired both of you.                                                 Amit, I know that we want to get our fellows talking a little bit more about Circulation On The Run. Can I hand it over to you now? Dr. Amit Khera:                 Sure, absolutely, and thank you Carolyn for handing the baton.                                                 I first want to give my full disclosure. I'm a Fellowship Program Director and of all the hats I wear, I find that to be one of the most important ones. You know, at Circulation, we certainly appreciate that Fellows-in-Training are the future of cardiovascular medicine and cardiovascular science. We are actively looking for ways to better engage the Fellows-in-Training and to make sure we're meeting their needs and enhancing their career trajectory. So, I appreciate both of you being on the call today and for this inaugural Fit podcast series, and this will not be the last of this series. So, we look forward to doing more.                                                 Maybe I will ask each of you individually, and I'll start with you Mayooran, can you tell me a little bit about how you consume the medical literature. I appreciate that it's generational and back in the day, everybody would get their print copy in the mail and now there's many different ways to consume it. Tell me a little bit about how you go through the medical literature and your way around that. Dr. Mayooran Namasivayam:      I tend to do a regular periodic browsing of the online journals. I tend to have a few journals, one of which is Circulation that I read sort of on a weekly or at most, fortnightly basis. Just to dig out the key articles of interest and the major updates. At our hospital the fellows have a weekly journal club meeting, which I actually chair. It's quite refreshing to get everyone's different opinions in their own areas of interest from the fellows to discuss topics of interest from various journals.                                                 So, for me personally, it's a combination of browsing online journals with combining a more formal setting as our journal club. But from a research perspective, I use things like the RSS feeds and Journal Alerts, so journal articles that come up in key topics of research interest for myself. With regards to clinical practice, I tend to browse. Speaking to colleagues of mine, they use various things like social media or apps which will highlight major developments or summarize key articles. I think increasingly, that will be the way forward. But that's the way I go about it. Dr. Amit Khera:                 What I really like what you said were a few things. Obviously there's an overwhelming amount of literature and by using tools like RSS feeds and table of contents, you can sort of keep up. I like that you're complementing that at your institution with this deep dive of journal club; this thing that many institutions including ours do, where you're really vetting articles in detail and hearing different perspectives. So, a nice blend of ways to consume it.                                                 Punag, I'm going to ask you a little bit about social media. When I looked, turns out CVD REAL, the one that you chose, had an altmetric score of 487, so we think of impact factor, but altmetric's a whole other way to look at impact of our articles.                                                 I'm curious about your thoughts on social media and the place of social media with disseminating scientific literature. I know many fellows are actively involved on Facebook and Twitter and other pathways. Tell us a little bit about your thoughts on that. Dr. Punag Divanji:            You know, very similar to the practice described in Australia, it's very similar to what we do here. We have weekly journal clubs, we discuss these articles with the faculty and really try to integrate it into our practice. A big part of that at, I think, many institutions across the country is the use of social media.                                                 It is particularly robust, I think, in the cardiovascular field, especially at national or international meetings wherein late breaking clinical data is rapidly disseminated. The outcomes and a few important trials that will impact clinical practice are rapidly disseminated, such that we are able to, I think, quite quickly access information, but beyond that, learn for example, the description is such that medical literature is doubling every two to three years. It's difficult to keep pace with that, but when thought leaders in the field present data that they find most interesting, most useful, or most relevant to patient care on a platform like social media, it's, I think, a wonderful way for Fellows-in-Training to quickly aggregate high quality data. It's something that I rely on heavily. Dr. Amit Khera:                 I think that's a great point, and where things have changed now is not only can you get information quickly through social media, but as you pointed out, the ability to interact with luminaries in the field to get their opinion on it and even engage in a conversation. That certainly wasn't available several years back and I think it's a great advance for Fellows-in-Training.                                                 I'm going to stick with you for a second and hear your thoughts a little bit on how Circulation may better engage Fellows-in-Training or meet their needs.                                                 How can Circulation or other journals for that matter help in the pathway for Fellows-in-Training? Dr. Punag Divanji:            I think the concerns of Fellows-in-Training are unique in comparison to those already in practice. We are at a point in our careers where we're trying to learn the basic important groundwork of cardiology, but at the same time, given the rapid evolution of data, it's imperative that we have the ability to learn new things on top of that foundation.                                                 Engaging fellows in that way, I think, involves a strategy that looks at a couple of different things. One is obviously social media, which is, let's be honest one of the core ways that trainees interact, and let's be honest, one of the most common things you see a trainee doing is looking at their phone. Dr. Amit Khera:                 And faculty. Dr. Punag Divanji:            And faculty for that matter, fair enough. But if you're able to provide information via Twitter or via this Circulation app and be able to alert someone of a new update in the field or a new guideline document or a way to better risk stratify patients that come in with myocardial infarction, this type of rapidly accessible data I think plays well to the [ethos 00:15:32] of the fellow wherein we like to be able to do things quickly and effectively, but also expand our knowledge in the most efficient way possible. Dr. Amit Khera:                 That's very insightful. So, if I hear you correctly, it's sort of continuing to make sure that we disseminate information quickly and rapidly to Fellows-in-Training in a way that is easy for them to consume.                                                 This brings to the point about when we look at our metrics, the podcast and other digital media strategies we have really hit broadly in an international audience, which we're very excited about.                                                 Certainly, Mayooran, I'm going to ask you as well your views on how can Circulation or other journals for that matter help engage Fellows-in-Training or enhance their training and career trajectories? Dr. Mayooran Namasivayam:      I guess today is a wonderful opportunity for fellows to participate in Circulation's online activities and engage with fellows from around the world, so this is one such example. I think echoing some of the thoughts of Dr. Divanji, as a fellow, you're doing many things and you're wearing many hats. You're learning new procedures, you're learning core cardiology, you're involved in research, you're doing on-call activities and clinical duties, and sort of amassing the latest evidence and putting that together and working out how that's going to change your practice now and in the future is important, but is not always easy to do.                                                 I think features such as Circulation's podcast, which summarize key developments sort of state-of-the-art review articles, guideline summaries, which come out in Circulation, and even the simple things like the summaries that come out on the print journals which say what is new and what are the clinical implications, which allow us to read that in a minute or two, and then read on if we're so interested, but at least get a summary or a snapshot of a major article. I think those features are really key in sort of summarizing key developments in a short and accessible way. I think as been discussed already, engaging with the newer media, social media, online media in the way that other publishing modalities such as newspapers are sort of engaging with their audience I think, is certainly important in the future to an increasingly time-poor audience. Dr. Amit Khera:                 Well, glad to hear that these features are resonating well with you both and it's certainly helping you in terms of accessing and understanding the relevance of these articles in your daily practice.                                                 The final question, I'll finish with you and then come back to Punag, is, as Carolyn says every week, this is your backstage pass to the editorial process, so a way to look behind the curtain or Oz if you will on how journals work and we certainly strive for transparency at Circulation.                                                 So, I'm going to maybe ask you if you have any questions for us on how the journal works or any questions regarding the editorial process? Dr. Mayooran Namasivayam:      I guess one of the things that I was wondering was you must, particularly at Circulation, just be inundated with a huge array of papers, which I'm sure all are of excellent quality.                                                 When you're looking at a paper quickly to make a decision about whether it's something you'd pursue further or look into, what gives you that instinct that you know this is probably a good paper? Is it the abstract? Is it the cover letter? Is it the title? What gives you that first impression that we should really look into this a bit further? Dr. Amit Khera:                 Well that's a fantastic question. I'll answer and I'll see if Carolyn wants to add anything as an associate editor as well.                                                 First you have to realize that yes, there's enormous volume of papers, but the most important thing is to assemble an expert team. I think Dr. Hill, our editor-in-chief, Joe Hill has certainly done that. He's established an international group of associate editors that are well-accomplished across the breadth of cardiovascular spectrum, so your interest is in heart failure, you have a couple of imaging type articles, Punag has talked about women's cardiovascular health and also diabetes and cardiovascular disease. We have editors that really have expertise on each of these areas.                                                 The first level is our editorial, editor-in-chief, and deputy editors, et cetera who'll take the first pass at which articles seem to be well done and would meet priority for Circulation. Then distribute them to editors that are content experts, that really understand those areas well. I take that responsibility very seriously when I get a paper. I know I've been on the other end of that. It's a tremendous amount of work. All the authors have contributed, patients have contributed their data. So, we take that responsibility incredibly seriously.                                                 We try to be thoughtful, that if it's a paper that really will not meet priority, we should turn it around quickly and let the authors know that so that they can then move onto another journal and not waste time. The flip is, if something seems that in our field, in our expertise would meet priority to our readers and could advance the field, we send it out for expert review, then have a very thoughtful discussion, even in advance online, through a web portal and then as a group with all of our editors across the world, to really think critically about each paper, it's merits and ways to strengthen it. We always try to do that, which is to not only say yes or no on a paper, but what can we tell an author to make a paper better, because we want the very best products coming out on Circulation.                                                 I hope that gives you an idea of how we think about it. It's sort of a tiered approach, starting with our editor-in-chief and deputy editors and then down to associate editors. Again, we try to turn it around, how would we want our papers treated if we were submitting to a journal?                                                 Carolyn, do you have anything to add to that. Dr. Carolyn Lam:               Yeah.                                                 So, Mayooran, that's great question. I think I can guess where it's coming from, sort of if one were to submit a paper to Circulation, is there any particular part that you would want to focus on, because that's the part that immediately catches our attention, right? I think that's what you're asking.                                                 Well, I would say without a doubt it's the science. So, you talked about the cover letter, you talked about abstract and things, the most important bar that the paper has to cross is validity. Then, right next to that would be novelty. So, for us, you know, once we can see that the science is well done and the results look robust, that has to be there before anything even happens beyond. Then, that's when the process kicks in like Amit said. Then we look at it from our specialty points of view and make sure that it's something novel and something that would be of interest to our Circulation audience.                                                 Does that answer your question? Dr. Mayooran Namasivayam:      It does. It does, thank you both very much. Thank you. Dr. Amit Khera:                 All right, I'm going to now pitch the same question to you, Punag.                                                 What are your thoughts? What sort of questions you have for us behind the curtain of Oz and the editorial process? Dr. Punag Divanji:            You know it's quite interesting, one of the most compelling components of the Circulation on the Run podcast is at the end when Dr. Lam has a wonderful discussion with the associate editor that was responsible for the article and the authors and gives us an idea not only of what drove their process of scientific discovery, but also what drove the editors to really believe in that article to warrant publication; to say that this is something that our readers need to see. I think that really quite remarkable to gain that point of view.                                                 My question is, you seemed to strike this balance between basic translation and clinical research when publishing each week. There are often a variety of topics that come from all three fields. Each week in the publication, there seems to be this balance between basic translational and clinical research wherein the readers really are able to gain perspective into the entire field of cardiology from articles that range from clinical outcomes from blood sugar management to the [pathophysiology 00:22:57] of takotsubo syndrome.                                                 How do you, as editors, strike that balance in each issue? How do you decide which articles are going to be published in concert with others? Dr. Amit Khera:                 That's a great question. Sort of looking at the spectrum of types of articles and types of science and how do you decide sort of what goes together. Kind of like a meal, you know, what components go together. Dr. Carolyn Lam:               I'd like to call it wine paring. Dr. Amit Khera:                 Wine pairing. I like that. So, if it's a roast, what sort of red wine and so forth. I think that's an excellent question.                                                 I think first, we do strive for balance and that, as you know, Dr. Hill has a ... his lab is a basic science lab, and Circulation has always been a journal which does the hightest quality science including both basic science and clinical and translational research. I also say we have other offerings as you know, which are thought pieces on my mind, and perspective pieces. So we really try to have the full spectrum. As we talk about, there are many people that enjoy their vegetables, the hard core original research articles, but a lot of people also like the deserts and the appetizers, these other types of articles that I mentioned.                                                 I think it's trying to find that right balance. We always like to have a balance of all of those together, because we appreciate there's a spectrum of readers and at the same time, we also appreciate that I'm more of a clinical researcher, I can gain insight and value from reading basic science research and similarly the basic scientist could gain value from the types of clinical articles we try to place in Circulation.                                                 So I think maybe as was mentioned, a little bit of a menu and a wine pairing we include this whole spectrum of different types of offerings, but I think the one bar is they all have to be articles that have some clinical implications, be it clinical, translational, or basic science, even the epidemiologic studies research that I do, they all have to, in the end, have some sort of clinical importance or relevance. I think that's the benchmark for all of the articles.                                                 Carolyn, do you want to add anything? Dr. Carolyn Lam:               No, I think you got it all. In fact, Amit, I'm going to turn it back to you for the last question.                                                 As Editor of Digital Strategies for Circulation, tell us, what's in store? Dr. Amit Khera:                 Well, you know, it's been a great first year and I think many would say one of the highlights has been the podcast for sure. I think we've developed a platform of social media engagement, of learning how to work though our digital strategies platforms and setting a high bar for our podcast.                                                 Now it's time to go to level two, or next level. How do we enhance what we're offering? How do we get creative about new types of podcasts, like this one we're doing today? How do we think about more interactive social media engagement? How do we further enhance the way we distribute science across the world? So, we have a big appetite and big ambition, but I think that is what we should be doing when we have such good science and making sure we disseminate it broadly.                                                 So, I think you'll see building on the platform we've already established, and apropos to today, I hope we really bring the Fits along with us on this ride to further expand our offering of our science. Dr. Carolyn Lam:               Thank you so much for joining us on this special episode. Don't forget to tune in next week.

  Speaker 1: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Joining me in just a moment are Dr. James Gammie and Dr. Timothy Gardner to discuss our feature paper this week describing the first-in-human clinical experience with a novel transapical beating heart mitral valve repair.     First, here are the highlights of this week's journal. The first paper is from co-primary authors doctors Yoon, [Tsue 00:00:49], and [Cha 00:00:50] as well as corresponding authors Dr. [Che 00:00:55]  and Dr. Kim from the Seoul National University College of Medicine. These authors examine mechanisms underlying diabetes-induced microvasculopathy, testing the hypothesis that Notch signaling in endothelial cells may play an important role in this condition.     The authors tested this hypothesis by inducing diabetes in eight-week-old adult mice using intravenous streptozotocin. They then modulated endothelial Notch signaling using chemical inhibitors in both wild type and transgenic mice. Results showed that the Notch ligand called Jagged-1 was markedly increased in endothelial cells of diabetic mice. Using endothelial specific Jagged-1 knocked down mice, they found that blocking Jagged-1 prevented diabetic microvaculopathy. Furthermore, using the induceable endothelium-specific Jagged-1 knocked down mice, blocking Jagged-1 even at four weeks after the establishment of diabetic microvaculopathy could reverse the condition.     In summary, these findings show that diabetes induces Jagged-1 over expression and suppresses Notch signalling in endothelial cells leading to diabetic microvaculopathy in adult mice. The clinical implications are that dysregulated intercellular Notch signalling may therefore represent a novel molecular target in the treatment of diabetic retinopathy.     The next study by Dr. Smith and colleagues at the Leiden University Medical Center in the Netherlands evaluated the association between LDL cholesterol variability and four cognitive domains at 30 months in the 4428 participants of the prosper study.     Results showed that a higher LDL cholesterol variability was associated with lower cognitive test performance for intermediate and delayed memory-related tasks, selective attention, and processing speed. Higher LDL cholesterol variability was also associated with lower cerebral blood flow and greater white matter hyperintensity load in an MRI substudy of 535 patients.     In addition to being independent of the mean LDL cholesterol levels and of clinically overt cardiovascular diseases, these associations were present both in the placebo and pravastatin treatment [inaudible 00:03:43] of the prosper trial suggesting that the findings did not mearly reflect pleiotropic effects of statins or of nonadherence.     The study importantly provides the first observational evidence that lipid variability, not just absolute or mean values, but the variability, maybe of importance to neurocognitive function and thus contributes while understanding potential pathways of neurocogniticve decline.     The next study is by first author, Dr. [Huh 00:04:19], and corresponding author, Dr. Ralph, from the Menzies School of Health Research Charles Darwin University in Australia. These authors aimed to investigate the long term outcomes from acute rheumatic fever and rheumatic heart disease.     They achieved this aim by using linked data between the rheumatic heart disease register, hospital data, and death register for residents of the northern territory of Australia, and examined 1248 patients with rheumatic heart disease as well as 572 patients with acute rheumatic fever in the period 1997 to 2013.     The main findings were that in the first year after an acute rheumatic fever episode, the incidents of progression to rheumatic heart disease was 10 times higher than acute rheumatic fever recurrence; 10% of rheumatic heart disease patients had severe disease at diagnosis. The presence of comorbidities was associated with higher incidence of rheumatic heart disease complications and mortality. In particular, comorbid renal failure and hazardous alcohol use accounted for 28% of the access indigenous mortality.     These findings have global relevance for settings with high acute rheumatic fever, rheumatic heart disease rates and really emphasized the need for integrated chronic disease management strategies for these patients.     The final paper is by first author Dr Bettencourt, corresponding author Dr. Blankstein, and colleagues from Brigman and Women's Hospital in Boston, Massachusetts. These authors sought to answer the question what is the most appropriate score for evaluating the pretest probability of obstructive coronary artery disease?     To answer the question, the authors compared the Diamond-Forrester score with the two CAD consortium scores recently recommended by the European Society of Cardiology, and they did this in 2274 consecutive patients without prior CAD referred for coronary CT angiography. CT angiography findings were used to determine the presence or absence of obstructive CAD defined as 50% or more stenosis.     Here's a refresher of the different probability scores. The Diamond-Forrester score is calculated based on chest pain type such as non-anginal, atypical or typical angina, gender, and age. The first CAD consortium model score called CAD consortium basic is also based on these factors, but was developed using more advanced statistical modeling strategies which were not available when the Diamond-Forrester model was derived. Additionally, the population had a lower prevalence of disease than the original Diamond-Forrester derivation cohort.     The second CAD consortium score called CAD consortium clinical included the same characteristics as CAD basic, but also included the following clinical risk factors; diabetes, smoking status, hypertension, and dyslipidemia. Moreover, the presence of typical chest pain was weighted less in diabetics compared to nondiabetics in the CAD clinical score.  Results showed that among symptomatic individuals referred for coronary CT angiography, the CAD consortium clinical pretest probability score demonstrated improved calibration and discrimination for the prediction of obstructive CAD compared to the Diamond-Forrester classification.     Driving home the clinical implications of this, the authors applied these observed differences in pretest probability of obstructive CAD to guidelines-based patient management algorithms and projected that the use of the newest score could decrease the proportion of individuals in whom testing would be recommended and increase the yield of diagnosing obstructive CAD.     Those were the highlights of these weeks issue. Now, for our feature paper. Our feature paper today is about the first-in-human clinical experience with the transapical beating heart mitral valve repair using a expanded polytetrafluoroethylene chordal insertion device. We're really lucky today to have the first and corresponding author, Dr. James Gammie from the University of Maryland Medical Center as well as Dr. Timothy Gardner, associate editor from Christiana Care Health System to discuss this exciting paper. Welcome, both of you.   Tim: Thank you.   James: Thank you.   Speaker 1: James, may I start with you? What an exciting title, a first-in-human experience, and this is really sounding very reminiscent of our experience with TAVR and aortic stenosis valves. Could I ask you, with so many exciting things, what is it about the results that excited you most?   James: This is an exciting project in that we believe it affords a new treatment option for patients with degenerative mitral regurgitation. We believe that this is a less invasive way of achieving surgical grade reduction of mitral regurgitation. This is a project which has involved a great number of people on our team both within the university and then within Harpoon Medical, as well as our colleagues in Europe to bring this device from an idea which was asked more than a decade ago into a clinical experience.     It really rose out of our recognition in particularly my own practice that virtually, every patient with degenerative mitral regurgitation could be fixed with ePTFE or Gore-Tex neo-chords, and the question became how can we place neo chords on a prolapsed mitral leaflets without doing open heart surgery?     We begin working on that in the laboratory a number of years ago and went through a variety of prototypes, and ultimately, came up with this idea where we could use a 3 millimeter shafted instrument with a specially designed wrap of Gore-Tex on a 21-gauge needle such that we could land on the underside of the mitral leaflet, deploy device, and create a specially designed knot on the atrial surface of the leaflet, and that would anchor the ePTFE on the leaflet. We could repeat that a few times transapically and then adjust the length of those chords in real time using transesophageal echo guidance.     We got this to work in the laboratory and we had hoped that we would have some modest success in humans, but we've been quite pleasantly surprised that it has just worked and we've outlines this initial clinical experience in the manuscript.   Speaker 1: First of all, I'd just like to pick up on the point that this is degenerative mitral regurgitation, so this is limited to the primary mitral regurgitation, not secondary?   James: That's correct and we know that right now, at least in North America, that two-thirds of mitral valve operations are done for degenerative disease. That's correct.   Speaker 1: I think a lot of the audience out there is going to be wondering how this new technique compares to the MitraClip. Could you tell us a little bit more about that?   James: I do MitraClip as well, so I think I'm well positioned to comment on the differences. The Harpoon device right now is still in operation. It does require a small one or two-inch incision. We anticipate it's going to be a thoracoscopic approach in the very near future and then, beyond that, we would hope to extend it to a transcatheter approach. That's one difference.     The MitraClip now is certainly across the world. It's used predominantly for functional mitral regurgitation. In our own experience, it seems to work best for functional mitral regurgitation and as you know, there are anatomic limitations for MitraClip in degenerative disease. The MiraClip replicates the LCRA surgical approach and I think what we've learned from all the less invasive approaches to treat mitral valve disease is that we have to respect what we've learned from our surgical experience, and we know that the LCRA approach works best when it's combined with an annuplasty ring, and certainly, the MitraClip, again, is mostly this perfunctional MR.     Another point I'd bring up is that the experience with MitraClip has been that when you place a MitraClip, you get a fairly strong fibrous reaction and in most of the series, it's not been possible to then go back and surgical repair the valve, but you have to do a replacement because you've compromised the leaflets. Our own approach were simply putting Gore-Tex sutures in the leaflets and we believe that one advantage is that we're not burning any bridges, and that you can go back and do an open repair of you had to.     In our experience, you asked about our results, we had great results in 10 out of 11 of our patients. One patient did require a reoperation. Actually, one of the chords had come untied on the surface in that patient. We were able to go ahead and do a repair and we saw as we had anticipated it based on our animal experience, there was not much compromised to the leaflets.     One of the advantages of our approach is that we can titrate the length to the Gore-Tex chords to optimize the amount of coaptation and maximize the quality of the repair, and that's something that we can't do an open cardiac surgery, and one of the challenges of mitral valve repair is that you have to figure out how long to make those chords while the heart is arrested and placid, and that's one of the challenges in why mitral valve repair is certainly some degree of an art to doing that.     What we've found is that the imager is incredibly important, and so we've teamed up with our echocardiography colleagues, and they really provide essential input into the procedure, and it's done not looking directly at the valve, but looking up at the screens. I think as surgeons, with this procedure, we're moving more into almost becoming interventionalists.   Speaker 1: Thank you, James. That was so exciting. Tim, I have to bring you into this now. Now that James has said they're becoming like the interventionalist. Back to my original comment of TAVR and aortic stenosis, are we witnessing history in the making now? You invited an editorial by Dr. Michael Mack and his title was very provocative, Transcatheter Treatment of Mitral Valve Disease. Is it deja vu all over again? What are your thoughts?   Tim: I think this is an exciting report and I think that this is the wave of the future. I agree completely with Michael Mack that we are beginning to see interventions for mitral valve disease that are effective, less invasive, in some instances catheter based, but this is just the beginning. In fact, mitral valve disease is somewhat more complex even than aortic stenosis, but this type of experience and the ingenuity and the technical prowess, and the ability to do this minimally, invasively, and so on really portend a whole new era.     I agree with Jim. This is sort of the common ground between the interventional structural cardiologist and the surgeon, and we're becoming even more entwined, more collaborative, and more mutually supportive. We are in a new era and I think over those next decade or so, we're going to see this and similar, and even different procedures tried and proven to be useful for the variety of mitral valve disorders that we encounter. Perhaps the era of the full sternotomy for fairly straightforward, single, focused operations will become something of a thing of the past.   Speaker 1: That's beautifully put. James, with that comment, what are the next steps?   James: As we said in the manuscript, this isn't barely experience and we're continuing to learn as we move [inaudible 00:17:07] to the clinical arena. We are currently in the midst of a CE Mark trial in Europe. We rolled it out to eight separate centers. As we approve clinical experience, we will learn more about precisely which patients work best with this approach and we will accrue longer term data. We now have a number of patient out to a year with stable results and so, as the numbers go up, we'll do that, and then we anticipate a randomized trial in the United States in the early to mid portion of 2017 where we'll compare this approach to conventional open cardiac surgery.   Speaker 1: That's fantastic. Thank you so much to both of you, gentlemen, for joining me on our podcast today.   Tim: Thank you.   James: Thank you.   Speaker 1: You've been listening to Circulation on the Run. Thank you for joining us this week and don't forget to tune in next week.