Mayo Clinic Talks

For several decades, rheumatologists have documented the elevated risk for cardiovascular disease of patients with autoimmune disorders such as rheumatoid arthritis and lupus, but it has only relatively recently entered the cardiovascular literature. In this episode, Drs Sharon Mulvagh and Rekha Mankad discuss the role that inflammation appears to play in disease, what special treatment and additional screening for CV risk is appropriate for this patient set, and how the guidelines are changing to incorporate those with autoimmune disorders.

Having discussed patient selection for transplantation in their previous recording, Drs Sudhir Kushwaha and Rocky Daly—respectively the medical and surgical directors of the heart transplantation and ventricular assist device (VAD) therapy program at Mayo Clinic, turn their attention to management of the patient in the perioperative and postoperative setting. In a rapidly changing field, they share their expertise with the latest options in immunosuppressive strategy and thoughts on the long-term management of those who have had a transplant.

With over 30 years of procedural experience, the surgical repair of the mitral valve has become the gold standard for the treatment of severe mitral regurgitation. Dr Rakesh Suri joins Dr Hector Michelena to discuss the genesis of the minimally invasive robotic approach to mitral-valve repair with tips on timing, safety, and a review of the relative advantages of the newer approach.

Dr Harold Burkhart joins Dr Frank Cerra to review the use of robotics and other minimally invasive techniques in congenital heart patients. They discuss the origins of robotic surgery, the patients for whom the procedures are appropriate and what they involve, as well as the rise of hydrid procedures—involving both catheter-based technologies and surgery—and treatment for hypoplastic left heart syndrome.

Drs Chet Rihal and Kevin Greason share Mayo Clinic's expertise in transcatheter aortic-valve replacement with insight intended for centers embarking on new programs. Among topics, they discuss: the key determinants of prognosis, the learning curve, addressing the risk of perioperative stroke, appropriate antiplatelet and anticoagulant therapies, access sites, and the importance of the "preflight check list."

After showing promising results in early-phase trials for ischemic heart disease, stem-cell therapy is now being examined as a possible mechanism to treat congenital diseases such as hyperplastic left heart syndrome. Drs Harold Burkart and Timothy Nelson discuss researchers' efforts to understand the origins of congenital heart diseases and how regenerative therapies might one day fit into this framework.

After years of being omitted from clinical trials, research is finally taking strides to recognize the specificity of heart disease in women. Dr Sharon Mulvagh joins Dr Bernard Gersh to ask why wouldn't there be differences in heart disease between women and men. Evidence now shows that what was once dismissed as a "false positive"—when a woman presents symptoms in a functional study but no evidence of anatomic constructive coronary disease—may indicate microvascular disease and be reason for great concern. Learn more.

Despite the ever shrinking size of devices and our greater technical expertise, there has been a disproportionate rise in the rate infections associated with cardiac devices. Drs Raul Espinosa and M Rizwan Sohail join Dr Charanjit (Chet) Rihal to discuss the possible explanations and best known measures to keep infection at bay. They review types of infections, how diagnosis is made, the thorny issue of TEE, and practical suggestions for extraction and reimplantation of devices.

Which patients are the best candidates for heart transplantation? Drs Sudhir Kushwaha and Rocky Daly—respectively the medical and surgical directors of the Heart Transplantation and VAD therapy program at Mayo Clinic—review the steps to selecting patients for transplantation and discuss ventricular assist devices (as bridge-to-transplantation and destination therapy) and the listing system that categorizes those awaiting surgery.

Research on spontaneous coronary artery dissection (SCAD) at the Mayo Clinic is a telling example of "patient-initiated" research made possible by social media. Dr Sharonne Hayes discusses with Dr Sharon Mulvagh the genesis of the SCAD project and the tremendous opportunities of the initiative, as well as the challenges posed by this new mode of interaction. Hear more about the powerful role that an online support group can play in finding answers for rare diseases and ultimately how social media can help shape research.