CTSNet Podcasts

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Drs. Michael Mack and Tom Nguyen about the proposed US Centers for Medicare & Medicaid Services changes to how cardiologists and cardiac surgeons interact during transcatheter aortic valve replacement (TAVR) procedures.

Chapters

00:00 Intro

Dr. Mack explained the current heart team system, established in 2011 through collaboration with the US Food and Drug Administration (FDA) and CMS, which has been highly successful in ensuring safe and effective TAVR implementation. He argues that the proposed CMS changes could potentially dismantle this collaborative approach by allowing asynchronous patient evaluation and procedures to be performed by single operators without surgeon involvement. Dr. Nguyen provided insights from a system leader's perspective, noting that while the proposed changes raise significant concerns about patient care and data collection, some cardiologists argue that surgeons are already not actively involved in many programs, making the single operator model the norm in practice. Both expressed concern that without mandatory surgeon participation and TAVR registry involvement, smaller programs may adopt practices that lack proper accountability and could lead to inappropriate patient selection and outcomes, potentially creating more contentious debates between TAVR and surgical approaches.

Joel also highlights recent JANS articles including a propensity-matched analysis comparing 10-year outcomes after SAPIEN 3 TAVR in the PARTNER 2 SAPIEN 3 Intermediate-risk Registry with surgery in the PARTNER 2A trial; a single-center retrospective study evaluated 61 patients who underwent cardiac surgery after prior TAVR during a 10-year period at a high-volume academic center; whether surgical aortic valve replacement (SAVR) should remain the first choice for aortic stenosis in patients with a life expectancy beyond five years; and an article examining the dramatic rise in the popularity of transcatheter aortic valves, early valve failure, and the impact it has on patients’ lives.

In addition, Joel explores axillary cannulation as a primary cannulation strategy, beating-heart endoscopic tricuspid valve replacement for high-risk redo patients after CABG and device-related tricuspid valve injury, and a Cox-Maze III operation combined with a left internal mammary artery (LIMA) to left anterior descending artery (LAD), as well as an ascending aortic replacement and aortic valve resuspension.

Before closing, Joel highlights upcoming events in CT surgery.

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Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Chris Malaisrie, a Professor of Surgery in the Division of Cardiac Surgery at Northwestern University and an Attending Cardiac Surgeon at Northwestern Medicine, about valve-sparing aortic root replacement techniques.

Chapters

00:00 Intro

The conversation covers a wide range of procedures, including the Bentall, Yacoub, and David operations, as well as the Ross procedure and personalized external aortic root support (PEARS). They further explore approaches to mitral and aortic valve repair, the management of diseased leaky valves, and the advantages of the Stanford modification of the David V procedure. Dr. Malaisrie concludes the discussion by offering advice to surgeons on refining their valve repair skills and shares his prediction for the future of valve repair surgery.

Joel also highlights recent JANS articles on age vs lifetime perspective on the transcatheter vs surgical aortic valve implantation, gene-edited pig cardiac xenotransplantation as a bridge to allotransplantation in infants, long-term outcomes of postoperative atrial fibrillation after cardiac surgery, and a case on ice water drowning survival after 147-minute submersion and 7 °C hypothermic circulatory arrest.

In addition, Joel explores double annular enlargement as an effective technique to overcome patient-prosthesis mismatch, reoperation for aortic root reconstruction, and normothermic treatment of an aortic arch aneurysm.

Before closing, Joel highlights upcoming events in CT surgery.

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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.

In this episode of The Cardiac Recovery Room, moderator Dr. Rawn Salenger, Chief of Cardiac Surgery at the University of Maryland St. Joseph Medical Center, USA, spoke with Drs. V. Seenu Reddy, a cardiothoracic surgeon at HCA’s TriStar Cardiovascular Surgery in Nashville, TN, USA, and Kevin Lobdell, Professor and Director of Regional Cardiovascular and Thoracic Quality, Education, and Research at Atrium Health, NC, USA, about postoperative rehabilitation and readmission prevention.

Chapters 

00:00 Intro 

01:51 Readmission Risk Factors 

05:17 Discharging Patients Living Alone 

07:31 Importance of Readmission Reduction 

10:21 Reducing Readmissions 

15:45 Postop Rehabilitation 

19:36 Bringing Rehab to Patients 

23:43 Behavior Modification & Engagement 

25:55 Coordination of Care 

26:36 Personal Engagement 

They explore various factors influencing patient readmission following cardiac surgery, encompassing both medical and social determinants. A significant focus is placed on the challenges faced by patients living alone, the associated risks, and the mitigation strategies that can be implemented to support them, noting how success is higher if patients have a social structure around them. Furthermore, the conversation highlights the importance of reducing readmission rates and using remote monitoring. They also examine the survival benefits of rehabilitation and barriers of postoperative rehabilitation, including transportation.

The Cardiac Recovery Room is the place to hear the conversations colleagues are having after the meetings. Each month, a new episode will be released featuring a leadership panel from the ERAS Cardiac Society.  

Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning discusses the Centers for Medicare & Medicaid Services proposed decision memo regarding the national coverage analysis for transcatheter aortic valve replacement (TAVR).

Chapters

00:00 Intro

He outlines crucial deadlines, actionable steps for surgeons, the importance of submitting public comments, and the necessity of data collection.

Additionally, he spoke with Dr. Robert Meguid, Professor of Surgery at the University of Colorado Anschutz Medical Campus, Aurora, CO, USA, about intraoperative molecular imaging. They explore how this technology identifies small nodules, the functionality and use cases of the specialized camera, the associated learning curve, and other available systems. The conversation also touches on robotics, lymph node staging, and cost. Furthermore, Dr. Meguid shares insights on his frequency of use of this technique.

Joel also highlights recent JANS articles on a systematic review and meta-analysis on how complete Dacron reinforcement of Ross autograft does not increase neo-aortic valve regurgitation, a randomized trial on superficial parasternal intercostal plane block with ropivacaine vs placebo for opioid exposure after cardiac surgery, and outcomes after conversion from mechanical to bioprosthetic valves for anticoagulation-related complications.

In addition, Joel explores the Ross procedure with internal and external reduction annuloplasty using autologous tissue rings, hemi-commando procedure for bioprosthetic aortic valve endocarditis, and left-sided uniportal VATS enucleation of a large esophageal leiomyoma.

Before closing, Joel highlights upcoming events in CT surgery.

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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.

In this edition of the CTSNet podcast, The Lifeline, host and nurse educator Jill Ley, Clinical Professor at the University of California San Francisco School of Nursing, Founder of the Essentials of Cardiac Surgical Resuscitation, and former Cardiac Surgery Clinical Nurse Specialist at California Pacific Medical Center in San Francisco, CA, USA, speaks with expert guest Amy Hackmann, adult cardiac surgeon at Brigham and Women's Hospital, Boston, MA, USA. Together, they explore extracorporeal membrane oxygenation (ECMO) vs emergency resternotomy for cardiac surgical arrest.

Chapters 

00:00 Intro 

01:36 Resuscitation Algorithm 

02:14 Current State of ECMO 

04:25 Speed, Quality Assurance 

08:28 ECMO Concerns 

12:16 Performance Metrics, Decision-Makers 

15:08 Prime Circuits 

15:24 Non-Surgical Arrest Training 

17:42 MCS Devices 

18:41 Instances to Avoid ECMO 

20:16 Time Targets 

21:58 Avoiding Complications, VIS Score 

25:09 Key Points 

The discussion covers quality assurance metrics, patient-specific decisions regarding ECMO vs resternotomy, and chest compressions. The experts also review the importance of advanced preparation, common causes of cardiac arrest following cardiac surgery, and small-incision surgeries, including the use of surgical saws. Furthermore, the discussion emphasizes the importance of mock drills and team training, as well as the use of ECMO on patients who have not experienced cardiac arrest. Finally, they explore scenarios where ECMO would not be used, vasoactive-inotropic score (VIS), and lactate levels.

Every month, The Lifeline features intensive care specialists sharing their expert insights into the rapid and effective management of critically ill cardiac surgical patients. Don’t miss next month’s episode!  

Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning discusses the transcatheter aortic valve replacement (TAVR) heart team potentially losing a member. He explores the current composition of the TAVR heart team, proposed changes, the thoughts of cardiothoracic societies, and future actions regarding this issue.

Chapters 

00:00 Intro 

01:53 TAVR Heart Team 

07:48 JANS 1, Base Editing of PCSK9 

09:47 JANS 2, High Volume Valve Sparing ARR 

12:03 JANS 3, Western Rheumatic Heart Disease 

14:05 JANS 4, Non-Intubated Uniportal VATS SL 

15:38 Video 1, Miami Method-Bentall 

17:02 Video 2, ALCAPA Repair 

18:29 Video 3, Robotic Cardiac Podcast 

22:17 Dr. Sundt, Mantle Radiation Patients 

31:17 Upcoming Events 

Additionally, he spoke with Dr. Thoralf Sundt, Chief of the Division of Cardiac Surgery and Director of the Corrigan Minehan Heart Center at Massachusetts General Hospital, Boston, MA, USA, about patients who have undergone mantle radiation. They discuss the challenges these patients face postoperatively, including the mortality rate associated with reoperations. The conversation also highlights the significance of employing a heart team approach for these patients, emphasizing the importance of preoperative planning and the application of TAVR, which is potentially suitable for these patients. Furthermore, they touch upon topics such as mechanical valves, porcelain aorta, and the importance of conducting careful operations on these patients.

Joel also highlights recent JANS articles on in vivo base editing of PCSK9 with VERVE-102 for hypercholesterolemia, defining high-volume centers using prospective data for valve-sparing aortic root replacement, insights from the Netherlands Heart Registration on surgical care for rheumatic heart disease patients, and a cohort study on surgical techniques and outcome analysis of non-intubated uniportal VATS sleeve lobectomy.

In addition, Joel explores a step-by-step technique for a minimally invasive Bentall procedure via right axillary access, the repair of an anomalous left coronary artery from the pulmonary artery via direct coronary transfer, and an episode of The Atrium podcast featuring host Dr. Alice Copperwheat speaking with Dr. Husam Balkhy about multi-spectrum robotic cardiac surgery. Before closing, Joel highlights upcoming events in CT surgery.

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Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Isaac George, CTSNet Board Member and Co-Director of the Structural Heart and Valve Center, Surgical Director of Structural Heart Disease, and Co-Director of the Mitral and Tricuspid Center at Columbia University Medical Center/NewYork-Presbyterian, NY, USA, about the lifetime management of aortic valve disease.

Chapters

00:00 Intro

02:11 AATS-CTSN Randomized Trials

04:37 JANS 1, Consensus Statement ALAD

10:28 JANS 2, Lung Re-Transplantation Outcomes

12:19 JANS 3, Aortic Homografts, EURECAH

15:15 JANS 4, Lobectomy Cost Analysis

18:10 Video 1, Anomalous L Coronary Artery

19:38 Video 2, Pulm Valve Replacement Reop

21:38 Video 3, Giant Pulm Artery Aneurysm

23:28 Dr. George Discussion

33:18 Upcoming Events

34:05 Closing

They explored the expansion of transcatheter aortic valve replacement (TAVR), emphasizing the crucial role of the heart valve team in this process. The discussion highlighted the necessity for surgeons to be actively involved in the decision-making process surrounding TAVR, particularly in the early stages. They also addressed the importance of lifetime management of the valve, selecting the appropriate valve, and valve durability. Additionally, they discussed the significance of providing patients with multiple surgical options, the Ross procedure, mechanical valves, and explored which procedures patients are choosing.

Joel also highlights recent JANS articles on the ISHLT consensus statement on acute lung allograft dysfunction, aortic homografts for native and prosthetic aortic valve and root endocarditis, how outcomes after lung re-transplantation for restrictive allograft syndrome have not improved over two decades, and the financial burden of postoperative adverse events following lobectomy.

In addition, Joel explores the surgical repair of an anomalous left coronary artery from the right pulmonary artery, minimally invasive pulmonary valve replacement in reoperative settings, and surgical management of giant pulmonary artery aneurysm using a T-shaped graft-valve strategy.

Before closing, Joel highlights upcoming events in CT surgery.

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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.

In this episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. Husam Balkhy, Professor of Surgery and Director of Robotic and Minimally Invasive Cardiac Surgery at the University of Chicago, IL, USA, about multi-spectrum robotic cardiac surgery.

Chapters 

00:00 Intro 

01:04 Why CT Surgery? 

04:08 History 

08:09 Benefits 

10:00 Challenges 

13:56 Multispectrum Robotic Surgery 

16:15 Patient Selection 

24:33 Work Up, Port Placement 

29:47 Valve Surgery 

31:11 Coronary Surgery 

32:38 Other Surgery 

37:15 Complications 

39:13 Training, Simulations 

45:07 Future of Robotics 

49:00 Key Takeaways 

49:34 Surgery Training Advice 

The discussion focuses on the history of robotics in cardiac surgery, emphasizing the benefits and challenges associated with robotic surgery. It explores the concept of multi-spectrum robotic cardiac surgery and provides an overview of robotic surgery as it currently stands, including the types of valves involved and the various approaches utilized. The conversation also highlights specific techniques in robotic surgery, such as totally endoscopic coronary artery bypass (TECAB). Additionally, it addresses potential complications, including peripheral cannulation injuries and phrenic nerve injury. Furthermore, they discussed training in robotics and the future of robotics.

The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Keep an eye out for next month’s episode. Related Resources

Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Joseph Coselli, Executive Vice-Chair of the Michael E. DeBakey Department of Surgery, the Cullen Foundation Endowed Chair, and a Professor in the Division of Cardiothoracic Surgery at Baylor College of Medicine, Houston, TX, USA, about thoracoabdominal aortic aneurysm repair.

Chapters 

00:00 Intro 

02:21 JANS 1, Ethical Leadership in CTS  

07:36 JANS 2, Dual Antiplatelet RCT  

10:27 JANS 3, Robotic MV Program  

12:00 JANS 4, Time of Day Outcomes  

15:34 Video 1, MI AV Replacement via RAM  

17:04 Video 2, LA & Pulm Cuff Dissection  

18:34 Video 3, LVOTE Master Class  

21:09 Dr. Coselli Discussion  

29:35 Upcoming Events  

29:59 CTSNet Profiles Update 

They discussed the increasing use of endovascular techniques and the declining prevalence of open surgery. Additionally, they emphasized the necessity of maintaining open surgery skills for certain cases and provided specific examples where these skills are essential. The conversation also covered the best spinal protection treatment, preconditioning the spinal cord, and hybrid approaches that combine open and endovascular techniques. Furthermore, they highlighted the importance of surgeons being involved in patient follow-up. Dr. Coselli also shared insights on future approaches and recommendations for individuals considering which subspecialty to pursue in cardiothoracic surgery.

Joel also highlights recent JANS articles on ethical leadership in cardiothoracic surgery in an era of consolidation, efficacy of dual antiplatelet therapy for three months vs 12 months after coronary artery bypass grafting, outcomes following the first 100 cases of a new robotic mitral valve program, and time of day of cardiac surgery and postoperative outcomes in the UK.

In addition, Joel explores minimally invasive aortic valve replacement via right anterior minithoracotomy, left atrial and pulmonary cuff dissection after heart and lung en-bloc procurement, and a master class with Drs. Sameh Said and Vince Gaudiani on the Konno procedure and left ventricular outflow tract enlargement.

Before closing, Joel highlights upcoming events in CT surgery.

JANS Items Mentioned

CTSNet Content Mentioned

Other Items Mentioned

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.

In this episode of The Cardiac Recovery Room, moderator Dr. Rawn Salenger, Chief of Cardiac Surgery at the University of Maryland St. Joseph Medical Center, engages in a conversation with Dr. Shuba Chatterjee, Associate Professor of Surgery and Director of Thoracic Surgical ICU and ECMO Program at Baylor College of Medicine in Houston, TX, USA, and nurse practitioner Amanda Rea, Lead of Advanced Practice and Clinical Program Manager in the Division of Cardiac Surgery at the University of Maryland St. Joseph Medical Center in Townson, MD, USA. Their conversation focused on hemodynamics and atrial fibrillation.

Chapters 

00:00 Intro 

01:17 Vasoplegia/Vasodilatory Shock 

06:13 Vasopressors, Cost Considerations 

07:32 Vasoplegia Misconceptions 

08:41 Defining Vasoplegia 

10:54 Blood Pressure Target Variable 

12:54 Inotropes 

17:03 Approach to Atrial Fibrillation 

19:08 Patient Monitoring 

19:27 Surgical/Concomitant Ablation 

23:13 Postop AFib, Preventive Strategies 

28:37 Example Scenario, High Heart Rate 

29:56 Out of AFib Into Sinus Rhythm 

33:01 Anticoagulation 

39:43 Key Points 

Key topics include vasoplegia, vasodilatory shock, and the use of vassopressors, including norepinephrine. They address common misconceptions surrounding vasoplegia shock, the role of epinephrine, and the use of methylene blue. Their conversation further delves into approaches for atrial fibrillation, concomitant surgical ablation, and postoperative atrial fibrillation. They highlight the best preventative strategies for atrial fibrillation and the use of beta blockers for atrial fibrillation. Finally, they discuss current guidelines and the role of anticoagulation in patients with atrial fibrillation.

The Cardiac Recovery Room is the place to hear the conversations colleagues are having after the meetings. Each month, a new episode will be released featuring a leadership panel from the ERAS Cardiac Society.

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.