#EACTS2021
Heart Team - does it still exist?

A very interesting session this morning - a 🧡
#EACTS2021
Dr Alfieri reminded us that medicine has a long history of collaboration between different specialties and areas of science/engineering

He gave the example of Lowell Edwards (engineer) & Albert Starr (surgeon) to create the ball-in-cage valve - same for Bjork-Shiley
#EACTS2021

Why do we have a Heart Team?

Dr Alfieri highlighted this can broadly be divided into these three categories. I really like this...
#EACTS2021

He used ischaemic cardiomyopathy as a great example of increasing complexity of the disease...and thus the wide number of skill sets required
#EACTS2021

This is the 3rd dimension - increasing array of therapeutic options for patients. He highlighted the multitude of options for aortic & mitral valve interventions available today
#EACTS2021

Are there potential downsides to this approach? Yes.

I really liked this SWOT analysis (Strengths; Weaknesses; Opportunities; Threats) that he presented
#EACTS2021

Next was a presentation by former ESC President and multi-modality cardiac imager Dr Jeroen Bax, who discussed the role and place of the Heart Team in the guidelines
#EACTS2021

Who is in the heart team? Lots of people!
#EACTS2021

Dr Bax explained the changes between the 2017 & 2021 ESC guidelines on VHD...explaining the reasons for including Heart Team discussions - usually for the most complex cases or ones in which several treatment options exist
#EACTS2021

A great flowchart showing the flow of care between networks

Last year, the @BrHeartValveSoc produced its Blueprint which discussed the importance of network-based care. Not all hospitals / centres have all options and expertise - and they don't all need to!
#EACTS2021

A great question - does *every* patient need to be discussed by the Heart Team, even where the decision is clear?

Dr Bax was clear the answer is NO - the Heart Team should be reserved for more complex cases. I agree. Most Heart Teams would not have time to do this
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Next talk from Dr Hendrik Treede on potential threats to the Heart Team approach - especially cost
#EACTS2021

Then a very interesting talk (for me!) on whether imaging still leads to best decisions for patients - pleased to hear early on a resounding Yes from Dr Unbehaun!
#EACTS2021

As minimally invasive and transcatheter procedures have increased, so has the need for 3D imaging to plan successful procedures
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Love these slides. Not only can imaging tell you if the procedure can be done, but also how hard it might be and what precautions might be needed.

Indeed, TAVI or TMVI without high quality imaging are impossible!

@AusamiAbbas
#EACTS2021

Great example relating to V-in-V TAVI...imaging can tell you likelihood of coronary obstruction and thus whether the #BASILICA technique will be required

True!
#EACTS2021

Final talk by @PeymanSardari on Education in Cardiac Surgery and the role of the Heart Team

Great first slide. Everyone loves Santa...but Santa does not exist...same for the Heart Team! πŸ˜†
#EACTS2021

Over 70 transcatheter devices on the market; none suitable for all patients...and no Dr can be expert in all of these...so, have to select the right device for the right patient to be done by right operator(s) in the right centre...and that'll need a Heart Team
#EACTS2021

Important points on this slide

Patient CoI referred to patients having done internet searches & coming to clinic with treatment plans already in place

It's a delicate balance; we should encourage patient empowerment and increasing their knowledge
#EACTS2021

"A successful episode of patient care is more than just them surviving the operation"

Dr Sardari Nia invited all to join the Heart Team Academy - a global effort to advance the field

Very true
#EACTS2021

What a superb final slide...love this!

Great session...hope you enjoyed this thread...more later!

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More from @dr_benoy_n_shah

15 Oct
#EACTS2021

This 🧡is related to Thursday's symposium on Edwards' Inspiris Resilia aortic bioprosthetic valve

The hospital in which I work used this valve for ~2yrs before stopping, so I was intrigued to hear the experts

A thought-provoking session!
@rafasadaba @GilbertTangMD Image
#EACTS2021

First talk from Prof Takkenberg, who needs no introduction to any of you. A very important talk in which she questioned the primacy of RCTs and spoke up on the importance of 'real world' registry data, often dismissed as poor quality Image
#EACTS2021

I learnt a new acronym today - GOBSAT!
Good Old Boys Sat Around the Table!
i.e. expert consensus, LoE - C! Love it!

She emphasised that a lot of our evidence, esp in VHD, is GOBSAT!

@mirvatalasnag @mrjzacharias ImageImage
Read 29 tweets
15 Oct
#EACTS2021

Good morning everyone!

Spoilt for choice, unsure which session to attend but I am at Controversies in Transcatheter valve treatments

First talk is on TAVI in nonagenarians (>90 yrs old) - is there a survival benefit? by @RoxanneStL

Great and vital question! Image
#EACTS2021

If someone has already lived far past the average life expectancy in their country and is now into their 90s, can we *promise* the patient that TAVI will make them live longer?

In our centre, we feel that patients >90 need to be very motivated to have a procedure
#EACTS2021

Retrospective study looking at everyone age >90 that had TAVI & then matched them to the Quebec general population that are >90 years Image
Read 35 tweets
15 Oct
#EACTS2021

This is a 🧡all about Transcatheter Mitral Valve Implantation (TMVI). If you don't know a lot about this and want to learn more - read on! This is a summary of a great expert focus session

First talk from Dr Gry Dahle (Oslo), on why TMVI is not the same as TAVI
#EACTS2021

1st TAVI was done 10 years before 1st TMVI

TAVI has revolutionised treatment of aortic stenosis; TMVI is further behind largely due to anaromical complexity of treating the MV compared to the AV - the AV valves are much more complex than the semilunar valves!
#EACTS2021

Historical timeline of the TMVI journey (left) and the large number of devices still competing for approval in the transcatheter mitral space (right)

@GilbertTangMD @mrjzacharias @BISMICS @SCTSUK @BrHeartValveSoc
Read 25 tweets
14 Oct
#EACTS2021

Abstract session on Hot Topics in Transcatheter Therapies

Presentation from Dr Justin Robinson on use of TAVI in patients with very large aortic annuli - Results from the Michigan TAVI Quality Collaborative
#EACTS2021
Methods here: just over 200 patients with aortic annuli in excess of the normal ranges for both the Edwards Sapien and Medtronic Corevalve systems
#EACTS2021

This was not easy to read. Key data here:

Mean STS score ~5%
Device success ~95%
Pacemaker - 6% Sapien 3 vs 11% Corevalve (p<0.05)
In-hosp mortality ~2%
Read 6 tweets
13 Oct
#EACTS2021

Great first day. My favourite presentation was on the Carmat Total Artificial Heart (C TAH), presented by Professor @netuka_ivan

@rafasadaba
#EACTS2021
The C TAH is probably the world's most advanced total artificial heart & is designed for patients with severe biventricular failure (i.e. for whom an LVAD would be insufficient).

It gained a CE mark last year and has an FDA approval for early feasibility studies
#EACTS2021

The device has an implantable prosthesis and an external power supply to which it is constantly connected
Read 14 tweets
4 Sep
This is a 🧡 about physical examination, and what role it (still) plays in modern clinical practice. Decided to write this after seeing a post earlier this yr by @RichardLehman1 on this issue and some people replying that examination was much less relevant in the modern era
I'd like to share 3 case examples of why I don't believe that is true. POCUS is a valuable *adjunct* to the initial clinical assessment, which includes both history & exam (H&E). The H&E should direct which tests you want & what Q you're asking

1. MR case
2. AS case
3. HF case
Case 1
Pt referred to @UHS_valveclinic with new murmur. Completely asymptomatic, very fit & active. Phys exam revealed a prominent systolic murmur, no other abN findings.

TTE images were hard...here is PLAX

@echo_stepbystep @iamritu @purviparwani @rajdoc2005 @mswami001
Read 23 tweets

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