Benoy Shah MD Profile picture
Oct 18, 2021 25 tweets 15 min read Read on X
Well, #EACTS2021 may be over...but I'm not done! 😆

One of the most important sessions was on Women In Cardiothoracic Surgery

I suppose I should clarify - not writing a 🧵on this for likes or 'virtue signalling' - my wife's journey through her training gave me some insights...
#EACTS2021
Opening talk on why @EACTS needs a womne's committee from @JolandaKluin - this was a great talk to set the tone for the session
#EACTS2021
Prof Kluin discussed the many challenges that can face women in medicine, in academic medicine, in surgery and in cardiac surgery
#EACTS2021
Cannot tell you how much I loved this point. Prof Kluin explained how she could have used either of these title slides - both are true, one more modest than the other, one more likely to be used by women than men. When one takes a step back & thinks about it...so true
#EACTS2021
Prof Kluin also alluded to constant challenges women face in all walks of life - even the President of the EC, Ursula von der Leyen, and the now infamous #sofagate episode - worth watching the video if you missed this
#EACTS2021
Next talk from @pompili_cecilia presenting the results of the EACTS gender bias survey
#EACTS2021
Started with male/female membership % in UK and Italy - extremely low in 🇬🇧
#EACTS2021

Impressive response rates - over 1100 replies, I think just over 2/3 from men and just under 1/3 from women (from memory!)
#EACTS2021

I think unsurprisingly, yet sadly, women much more likely to have considered leaving due to gender bias, or to have felt discriminated against at work on the basis of simply being a woman ☹️
#EACTS2021

Some important lessons here for those planning and in charge of surgical training. Women don't feel supported at work - don't complain we don't have enough surgeons, yet fail to stop behaviours that can trigger the loss of trainees!
#EACTS2021
Next talk from Dr Jasmine Hanke reporting results of the German survey on Women in Cardiac Surgery
#EACTS2021

I liked this summary slide of the multiple - really, it's *multiple* - challenges and career-limiting factors for women as a whole, not just in surgery
#EACTS2021

So...this is what they did...all centres responded. Dr Hanke was pleasantly surprised to learn that 24.7% of trainees were female, much higher than she expected / perceived
#EACTS2021

Just look at this...especially the top 2...😠

I'm pretty sure that will have been unsolicited 'advice' from men that may have thought they were 'trying to help'

More on this later...
#EACTS2021

Great talk next from Barbara Cador, who is a non-medic and gave a corporate / business overview of women in science - really interesting talk!
#EACTS2021

Started off by showing % of people in different countries that would be comfortable with a woman as a leader...why is this not 100%? Surely you want the best person, irespective of gender?

And look at Jacinda Ardern! Has there been a better leader in past 2 years?
#EACTS2021

I am sure this slide was depressing for women - only 74% of women perceive other women as equally suited for leadership roles as men - love the Madeleine A quote!
#EACTS2021

Finally, some practical tools and ideas for how to address these issues...I particularly like #2
#EACTS2021

Final talk from Dr Julie Cleuziou, addressing gender disparities in academic surgery
#EACTS2021
Great to see more women attending at meetings and presenting at them...

But still so few at some meetings are invited speakers and chairpersons
#EACTS2021

Men are more likely to invite men to participate in meetings, and women are more likely to invite women

So...if you want more women at your meeting, you need to involve women in *planning* the meeting!
#EACTS2021

Conclusions...
#EACTS2021
So...why do I feel this resonates so much? Well, apart from the fact that it is an obvious and big inequality - and most of us don't like inequalities - as I said above my wife - an anaesthetist - had a lot of nonsense from men in her training too
#EACTS2021
Decided on a career in anaesthetics, well on the way through training yet the frequent uninvited 'advice':
"Have you not thought above GP?"
"You know it's hard with children and the early starts"
"Do you need to work if your husband is a Dr too?"

etc ad infinitum
#EACTS2021
Tip to my fellow men - even though you may think this 'advice' is helpful, in almost all situations it isn't!

If your advice on a woman's career isn't sought...don't give it! Seriously, learn when to stfu!

End/

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More from @dr_benoy_n_shah

Oct 30
Deep dive on #EARLYTAVR from ##TCT2024

Lots already said & discussed

It takes time to read the paper, read the supplementary appendix, analyse the results, think about them etc!

Some thoughts...🧵 Image
On Sunday I wrote a thread about asymptomatic severe AS and what we knew already from RECOVERY & AVATAR RCTs and what the guidelines currently advocate

Here's the 🧵 in case you missed it

EARLY TAVR
Asymptomatic severe AS patients recruited between March '17 - Dec '21

75 sites across 🇺🇲 and 🇨🇦

Asymptomatic status confirmed by negative treadmill test in 90.6%
(Remaining 9.4% unable to do test, relied on detailed physician history)

That's a good % that did ETT 👏
Read 29 tweets
Oct 27
Tomorrow - Oct 28th - we learn the results of 3 landmark randomised studies in patients with aortic stenosis (AS)

Results of EARLY-TAVR, EVOLVED & TAVR UNLOAD will be unveiled at #TCT2024 in a Joint LBCT Session with #NEJM

These could well be practice-changing studies...

A 🧵 Image
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#TCT2024
The first 2 RCTS - EARLY TAVR & EVOLVED - concern the management of asymptomatic severe aortic stenosis (ASAS for this 🧵)

Currently, ASAS (with normal LV function) is not a Class I indication for valve intervention in either 🇪🇺 or 🇺🇲 VHD guidelines Image
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##TCT2024
There have been 2 RCTs of early intervention (surgery) vs routine care, aka 'watchful waiting'

It's worth reminding ourselves briefly of these studies, as the background is important in understanding EARLY TAVR in the right context
Read 21 tweets
Mar 17
*Mitral valve assessment by TTE*

Transthoracic echocardiography (TTE), when performed with care and diligence, can reveal a lot about the valve. TOE isn't necessary in all cases to determine leaflet pathology.

A worked example below:
In the PLAX view, you can assess the scallops of the leaflets

In a true PLAX view with aortic valve clearly visible, you mostly see the A2-P2 interface. Here, you can see a clear & large prolapse of the posterior leaflet
If you tilt upwards towards the PLAX RV outflow (pulmonary valve) view you see mostly the A1-P1 interface

Here, you can see the valve looks slightly different & no prolapse is seen
Read 17 tweets
Feb 29
Good teaching case for Fellows from a recent emergency scan

Happy heart or unhappy heart?

What can you deduce from these spectral Doppler traces of mitral (left) and tricuspid regurgitation (right)?

#echofirst #cardiotwitter #ACCFIT
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Lots of excellent replies. A lot of information to glean from 'just' the CW Doppler traces

The ECG is broad and with a pacing spike just before the QRS complex...so a pacemaker is in situ

MR trace: faint, not severe MR by jet density

But look at the MR Vmax, not even 4m/s!

1/
MR Vmax is normally 5-6m/s in normal LV function.

If the Vmax is a low as this, it either reflects a weak LV, or very high left atrial pressure...or both. It's often both

So the MR CW Doppler suggests:

a) significant LV dysfunction
b) non-severe MR

2/
Read 5 tweets
Dec 16, 2023
As we approach the end of 2023, what was the most important paper you read this year?

Mine wasn't in cardiology

I think this went under the radar a little, but it shouldn't have...the impact of private equity (PE) takeovers in healthcare

An end-of-year 🧵
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Before going further, we should clarify what PE actually is. Now, I am NOT a financial expert at all, but here goes...!

PE is essentially the investment of capital (equity) into a private (non-public listed) company or business. Read this for more 👇🏽

hbr.org/2007/09/the-st…
PE has garnered a reputation for huge profits as they typically buy into a company, aggressively ⬇️ costs whilst ⬆️ profit margins, leverage debt if needed, and then sell, often at a large profit

Does this matter when it comes to delivering healthcare services?
Read 15 tweets
Oct 11, 2023
Sixty years ago this month - October 1963 - US cardiologist Dr Robert Bruce published a paper detailing his efforts to devise a multi-stage treadmill test

Little did he know this would go on to become the Bruce protocol the most widely used for exercise testing

A thread...
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Prior to this, 'stress testing' to evaluate cardiac function was performed using the Masters 2-step technique, first described in 1935. This crude but simple test involved repeated steps up & down over 90 seconds

sciencedirect.com/science/articl…
Bruce, amongst others, recognized the limitations of this test & set about developing an exercise treadmill test

His initial work focused upon a single stage protocol, but he soon realized this wasn't stressing fitter patients enough & the test was taking too long!

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Read 12 tweets

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