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
01:21 TAVR Heart Team
04:08 JANS 1+2, JACC TAVR vs SAVR
12:19 JANS 3, TAVR Short-Term Outcomes
14:06 JANS 4, SAVR Life Expectancy
17:44 JANS 5, WSJ TAVR Article
19:19 Video 1, Direct AA Cannulation Technique
21:23 Video 2, Endoscopic Redo TVR After CABG
24:25 Video 3, Gaudiani Cox-Maze III
27:33 Dr. Mack & Nguyen, TAVR Heart Team
51:12 Closing

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.

JANS Items Mentioned

10-Year Outcomes of SAPIEN 3 Transcatheter Aortic Valve Replacement or Surgery in Intermediate-Risk Patients

A Decade of Cardiac Surgery After Transcatheter Aortic Valve Replacement: Short-Term Clinical Outcomes at a High-Volume Center

Great Debate: Surgical Aortic Valve Replacement Is First Choice for Aortic Stenosis in Patients With a Life Expectancy Beyond 5 Years

A Breakthrough Heart Procedure Comes With Risky Tradeoffs

CTSNet Content Mentioned

Direct Axillary Artery Cannulation With the Open Seldinger Technique

Endoscopic Redo Tricuspid Valve Replacement After CABG

The Cox-Maze III Procedure Combined With Valve-Sparing Aortic Surgery and CABG

Other Items Mentioned

Centers for Medicare & Medicaid Services Database—TAVR

Career Center

CTSNet Events

 

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
02:25 TAVR Heart Team Coverage
03:52 JANS 1, TAVR vs SAVR Perspective
10:50 JANS 2, Gene-Edited Transplant Model
13:13 JANS 3, Long-Term Outcomes Atrial Fib
14:31 JANS 4, 147-Minute Drowning Circ Arrest
18:01 Video 1, Double Ann Enlargement Prosth Mis
20:48 Video 2, Reop Aortic Root Reconstruction
22:24 Video 3, Normothermic AA Aneurysm
24:22 Dr. Malaisrie, Aortic Root Replacement
41:42 Closing

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.

JANS Items Mentioned

Transcatheter vs Surgical Aortic Valve Implantation: Age vs Lifetime Perspective

Gene-Edited Pig Cardiac Xenotransplantation as a Bridge to Allotransplantation in Infants: Progress in a Pig-to-Baboon Model

Long-Term Outcomes of Postoperative Atrial Fibrillation After Cardiac Surgery: Results From 19,000 Patients

Ice Water Drowning Survival After 147-Minute Submersion and 7 °C Hypothermic Circulatory Arrest

CTSNet Content Mentioned

Double Annular Enlargement as an Effective Technique to Overcome Patient-Prosthesis Mismatch

Reoperation for Aortic Root Reconstruction

Normothermic Treatment of an Aortic Arch Aneurysm

Other Items Mentioned

Centers for Medicare & Medicaid Services Database—TAVR

Career Center

CTSNet Events

 

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
01:17 TAVR National Coverage
06:05 JANS 1, EPOCH CardioLink-10 Trial
10:20 JANS 2, Dacron Ross Autograft Analysis
12:23 JANS 3, Mech vs Biopros Valve Outcomes
15:53 Video 1, Ross Procedure I/E Reduction
19:18 Video 2, Hemi-Commando Procedure
22:14 Video 3, Left VATS Enucleation Leiomyoma
24:15 Dr. Meguid, Intraop Molecular Imaging
35:52 Closing

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.

JANS Items Mentioned

Complete Dacron Reinforcement of Ross Autograft Does Not Increase Neo-Aortic Valve Regurgitation: A Systematic Review and Meta-Analysis

Superficial Parasternal Intercostal Plane Block With Ropivacaine Versus Placebo for Opioid Exposure After Cardiac Surgery (EPOCH CardioLink-10): A Multicentre, Double-Blind, Randomised Trial

Outcomes After Conversion From Mechanical to Bioprosthetic Valves for Anticoagulation-Related Complications

CTSNet Content Mentioned

Ross Procedure With Internal and External Reduction Annuloplasty Using Autologous Tissue Rings

Hemi-Commando Procedure for Bioprosthetic Aortic Valve Endocarditis

Left-Sided Uniportal VATS Enucleation of a Large Esophageal Leiomyoma

Other Items Mentioned

Centers for Medicare & Medicaid Services Database—TAVR

Career Center

CTSNet Events

 

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.