Structural and interventional Cardiologist. FACC,FSCAI. Tweet ≠ medical advice. Like/RT/Follow ≠ endorse. Tweets ≠ employer’s opinion. #CardioX
Birmingham, AL
Joined January 2017
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Today I finally used my extensive training in the Krebs cycle from undergrad and medical school to diagnose and treat a patient.
Just kidding. I rounded and did some caths.
Point being, interventionists need to be capable of performing all interventional procedures. The community needs what the community needs. We need to be trained more like our surgical counterparts as opposed to individual pieces of Interventional Cardiology.
Agree this is a huge issue. We’re stepping all over each other. IMO, training duration for IC should increase and include coronary, peripheral, and structural, while also dramatically decreasing trainee numbers.
You get much better pictures with a pigtail. It’s designed to dissipate the pressure equally and not whip wildly around the LV during injection. Agree, myocardial entrapment is rare, but mostly preventable with a pigtail.
Performing a high pressure LVgram with an end hole catheter is done for one of two reasons, ignorance or laziness. Neither are becoming of a professional. It takes 30 seconds to change to a pigtail.
I thought it was ironic that the same journal that taught many, if not most of us, critical appraisal of scientific medical literature would publish something so obviously confounded.
Matthew Sample retweeted
Interventional cardiology is largely a cognitive specialty rather than a technical one. Can’t have one without the other.
I don’t always agree with posts by @georgetolisjr, but this is correct.
Much of surgery is technical.
But often, the cognitive part and decision making is the difference between life and death.
Fascinating. Minimal TAVR becoming more minimal all the time. If post TAVR CHB can be reliably predicted, routine same day DC on the horizon.
Agree 100%. Interventional Cardiology/CMS has a gate keeping problem.
Was encouraged to see the most recent TTVR CMS NCD not mention volumes. Hopefully this is a trend.
Strict volume requirements do limit rural access as well as limit where physicians can live and practice.
Honest question here because this is a new commercially available technology - how do new sites have any experience in TTVR if they were part of the clinical trials? Should this be limited only to sites that were in the trial? Does 50 vs 150 TAVR/yr make one better at TTVR?
What procedure(s) and volume(s) would you suggest matter the most to ensuring high quality TTVR programs?
David, I have absolutely no insight into that, but would hope that this suggests a new emphasis on outcomes and demonstrated expertise where before volume (of other partially related procedures) served as a surrogate. Do you have any insight here?
Owning three Labradors is a constant game of either What’s That Smell, Why Are You Wet, or Who’s Throw Up Is This?