Benoy Shah MD πŸ’™ Profile picture
President @BrHeartValveSoc Fatherβ€’Sonβ€’Husbandβ€’Cardiologist (Imaging) Echocardiography - esp stress & contrast πŸπŸ€πŸ“
Kingston Profile picture Simone Ferreira Leite Profile picture Yina toloza Profile picture 3 added to My Authors
18 Oct
Well, #EACTS2021 may be over...but I'm not done! πŸ˜†

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
Read 25 tweets
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
#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
#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
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!
#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
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
14 Oct
#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...
Read 21 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
22 May
1/ I know some of us have already had a brief discussion about this, but this is the most astonishing presentation I have seen in a long time.

We should discuss!

I must stress, I have *not* seen the actual presentation, I've seen the slides & write up on TCTMD only
2/ This study is derived from the TVT registry, looking at TAVIs with the Sapien 3/Ultra between 2015-2020

Of 159661 TAVIs, 37660 were in low risk patients (STS score <3%) & 3243 had bicuspid AV. They've propensity score matched to compare TAVI in BAV vs trileaflet AV valves
3/ Almost all the BAV pts made it into the propensity score-matched group (3168/3243 = 97.7%)

Mean age 69yrs
Mean STS score 1.7%
Mean LVEF 57%
Read 14 tweets
13 Mar
**VALVE CASE OF THE MONTH**
@BrHeartValveSoc

Pt in early 50s, unwell for 2 weeks. Grows Staphylococcus aureus in blood cultures within 48hrs. No obvious source. No murmurs on exam.

TTE requested - image quality not great, but here's a PLAX view of the AV.
Here's a still photo.
Red arrow indicates the strand we saw on the AV.
Seemed a bit long to be a Lambls, but could be; I've seen these described as a filament or fibrin strand too.
Importantly, no aortic regurgitation
Read 18 tweets
21 Dec 20
**VALVE CASE OF THE WEEK**

Last case of 2020!

@BrHeartValveSoc @TheBJCA @global_wic @BSEcho @ASE360

This is a tough one! This will separate the men from the boys, the women from the girls...are you Luke Skywalker or are you already the Obi-Wan Kenobi of valve disease?!
Mid 70s patient, known ischaemic cardiomyopathy & aortic stenosis.
⬆️⬆️ dyspnoea.
Clinical signs suggest severe AS.
BP 90/50mmHg, HR 60bpm.
This is the resting ECG (hint - showing this for a reason - πŸ˜‰)
Here is PLAX view of the AV...πŸ‘‡πŸ½
Read 25 tweets
26 Oct 20
**VALVE CASE OF THE WEEK**

Old case from 2010...but you know what they say...old is gold! 😁

Female, mid 70s, inter-hospital transfer for urgent angiography due to chest tightness with ischaemic ECG. CP came on 12hrs after distressing news of sudden family death. ECG πŸ‘‡πŸ½ Image
Exam - loud systolic murmur, so urgent TTE requested before angio. Here is PLAX. Apologies no ECG, cables on portable Vivid-i were broken!

@angularboxoid @JonathanWHinton @hannahcvimaging @cardiodan @hannahzr @TharushaGunawa4 @MayooranShan @DrMarkMills @dorsetcardio @brwcole
PLAX Zoom...
Read 28 tweets
10 Oct 20
#EACTS2020 Update!

What a busy day! Great session related to TAVI and discussion of low risk patients and insights from the πŸ‡ΊπŸ‡Έ TVT database containing results from over 330,000 patients! Read more below... warning, long but interesting (hopefully!) thread...
@EACTS @SCTSUK
First presentation included 2yr outcomes from PARTNER 3 trial from Dr Vinod Thourani πŸ‘‡
We were reminded of the 1year results presented last year at ACC

Significant difference in composite 1o EP at 1yr, endpoint was death / stroke / rehospitalization

At 2 yrs, similar results for this composite EP
Read 27 tweets
10 Oct 20
#EACTS2020 Update

Abstract - PERSIST-AVR RCT

Well, had to choose this! Not often there's a RCT in heart valve disease!

Study: Perceval sutureless valve vs a stented tissue aortic valve, both by full sternotomy and mini sternotomy approaches

@EACTS @BrHeartValveSoc
47 sites across 3 continents recruiting from 2016-2018

578 underwent isolated AVR

Mean age 75yrs
Authors report quicker surgery and better outcomes for the Perceval valve *in combination with* mini-sternotomy approach
Read 9 tweets
9 Oct 20
#EACTS2020 update

Abstract - MV repair or replacement in the elderly? Presented Friday

I was interested in this as I too have often wondered if repair is "necessary" or "correct" in the older patient

@EACTS @BrHeartValveSoc @SCTSUK @ctsnetorg @escardio @global_wic @TheBJCA
Retrospective study of patients age >70 undergoing minimal invasive MV repair or replacement

Propensity match scoring to balance differences in baseline characteristics
Mean age 76yrs
Good LV in >80%
AF in >50%
Read 10 tweets
9 Oct 20
#EACTS2020

Important πŸ‡¬πŸ‡§ data on mitral valve repair over a 15 year period, from 2002/03 - 2015/16
(Presented yesterday)

@SCTSUK @ctsnetorg @HeartValveOrg @BrHeartValveSoc @escardio @EACTS @BritishCardioSo
Over past 15yrs, the number of MV operations has increased and % performed as repair has also increased...
Repair rate in ELECTIVE mitral surgery is ⬆️

Recently, the repair rate in URGENT and EMERGENCY mitral surgery has ⬇️ slightly
Read 7 tweets
8 Oct 20
#EACTS2020

Starting now - Focus session on Challenges in TAVI in patients with >1 cardiac problem!

TAVI & CAD
TAVI & MR
TAVI & TR

Great talks, tune in now! 😁

@EACTS @VictorDayan1 @BCIS_uk @kaschenke @M_Pompeu_Sa_MD @EulertJ @dompagano @MadalinaGarbi @JGrapsa @doconmoney ImageImage
TAVI and Coronary Disease

Such a difficult topic! No RCTs. What do you do in these patients?
And, if your patient needs revascularization, do you *ever* do PCI and TAVI in the same procedure?
Read 4 tweets
21 Sep 20
**VALVE CASE OF THE WEEK**

OK, this starts off about valves...but then isn't really about valves...but it's the broader educational point (which is relevant to valves) that I want to make this week...no poll I'm afraid, but as always, comments encouraged! 😁

@BrHeartValveSoc
In my office doing Admin, lot to get through & a very busy morning ahead. Asked to r/v a TTE for helping determine AS severity. Pt admitted with heart failure, clinically severe AS is all I know at this point. Now, the golden rule in this situation is *review the whole study*...
Not just one or two images.

But I was super-busy, I BROKE MY OWN RULE and just looked at the relevant images. Here's the PW and CW Doppler tracings (Pt in AF)...
Read 15 tweets
19 Aug 20
**VALVE CASE OF THE WEEK**

In our hospital, we have seen 2 patients over the past 3 years that presented with acute heart failure and who had severe AR on echo with large, characteristic masses on the AV. This week's poll is simply... what do you think these masses are? (1)
Patient 1 - Female, early 60s, no major PMHx, admitted with 2 weeks worsening SOB and palpitations. No fever. In heart failure, BP 110mmHg systolic. AR murmur. Normal white cell count & near normal CRP on bloods. TTE below...zoomed PLAX view of AV (2)
Here is a TOE view...(3)
Read 12 tweets
11 Aug 20
**VALVE CASE OF THE WEEK**

@BrHeartValveSoc

I'm on holiday (staycation 😫) so I'll keep it brief! No poll. Experienced scanners will know this, but could hopefully be of use to physiologists and Fellows in training.

This case focuses on the concept of physiological MR...(1)
Patient having an echo for a different reason (i.e. not murmur) had this AP4Ch view in 2014...

This was reported as "mild MR" and a repeat echo was advised in 2 years...(2)
So the patient returns in 2016 for an echo...

Again reported as "mild MR" and again follow-up advised in 2 years' time...(3)
Read 10 tweets
21 Jul 20
**VALVE CASE OF THE WEEK**
@BrHeartValveSoc

32yr old lady with moderate mitral stenosis tells you in clinic she is planning on trying for a baby...is that ok? Denies any symptoms, feels well. Echo - mean MVG 6mmHg. RVSP ~ 20mmHg. What would you say / do / advise?
Parasternal X-plane...
Ap 4Ch zoom of MV
Read 14 tweets