Terence Hill

So proud of our team! Opened our second mTEER location today! @jgschwartzmd @AtriumSHVI @THillMD @SteveCl54400449 @MarkusSchererMD @SanjeevGulatiMD @garosemd

@SrihariNaiduMD @jaygirimd timeo Danaos et dona ferentes

@THillMD @jaygirimd It’s a legit fear. Money can be a powerful driver and take a life & goal of its own. But just think about what levers you have to change ABIM and now think about what you have to change and watch ABCVM. No doubt there’s gonna be trust involved but also responsibility.

My personal take to the new board based on what we know now: 👍direct response to ABIM charging high fees, perceived double dipping, lack of accountability (tone deaf), overreach (choosing wisely and other irrelevant campaigns to mission of certification), changing rules constantly, and making too much profit; 👍new board is all cardiologists so they get what we do and what we need - you can talk to the new board members anytime you see them (which we will bc they are at our conferences); 👍it’ll be cheaper but prob only 20-30% less initially as it’s built on loans to start; 👍if approved ABIM will have to stop doing anything in cardiology and everything switches to ABCVM, as both are under ABMS. Thus new board also assures hospital privileges and ACGME requirements are met; 👍whatever you’re doing and whatever stage you’re at in ABIM will be automatically transferred over (so don’t stop); 👍as a direction, goal is to get everyone to maintain certification - cardiologists know you passed once and you should be helped to keep certification - no threats of decertification - we need our workforce to be out there as we’re already short staffed; 👍the ongoing part after initial cert will be built on making sure you’re licensed, filling any gaps in knowledge, and basic attestation to a quality program. Questions will automatically send you to the CME module that teaches what you got wrong. Do that and you’re done (and actually more competent - it will feel useful and relevant); 👍logistically easier as everything you do in cardiology is generally already known in cardiology - so should be already uploaded centrally; 👍the professional societies make up the board so if you don’t like direction you can lobby your own organization to change things and at least for SCAI you could vote the president based on any issue including this one; 👍it won’t be perfect initially but over time should get better and better and closer to what we want bc there is accountability as described; 👍governance by the societies means it shouldn’t spiral out of control into its own beast for profit, especially as the societies have equal input to the board. If there is eventual profit that should go into lowering fees IMO and I will certainly push for that; 👍getting all cardiology organizations to agree on this was not easy and reflects that there will be constant push and pull to make things better. No one society will be dominant; 👍there’s a financial firewall so the societies don’t make money from the new board. They do get money if you choose their modules to close knowledge gaps but you have choice on whose modules you use. On balance it’s a no brainer. Please comment to move forward. End/

@nyalborgesmd @DrJayMohan @RajTayalMD @HadyLichaaMD @ShockwaveIVL @DrAmirKaki @ziadalinyc @SandeepNathanMD @djc795 @cardioPCImom @evandrofilhobr @SVRaoMD I actually like support for these, have done a few rota/shock cases where I’ve seen less pulsatility with shockwave than with rota

@DrJayMohan @RajTayalMD @HadyLichaaMD @ShockwaveIVL @DrAmirKaki @ziadalinyc @SandeepNathanMD @djc795 @cardioPCImom @evandrofilhobr @SVRaoMD Nice result Jay! Did one very similar the other day unsupported. Just have to take your time and allow recovery between pulses - don’t think impella is needed for all of these cases unless very decompensated. Agree with needing bigger IVL!

Ostial left main #lithotripsy Traditionally I’ve used rota atherectomy here but #IVL preformed well… ⚠️Needed #impella (lost pulsitility with cycles) 💝Allowed for less contrast/unbeatable safety ‼️We need bigger IVL balloon for LM 🔑Guide extension is key #Cardiotwitter

@abovethecarina @EM_RESUS Most of these patients do not have acute LM occlusion. Med therapy, echo, work up for causes of demand ischemia is where to start

⁦@EM_RESUS⁩ (and anyone else who’d like to weigh in) 68 yr old M w/HTN, HLD. 1hr acute CP. EMS gave ASA but held nitro d/t “soft pressures.” Where to start when seconds count? All I can think is ✴️ 🆘Aaaaccck BAD‼️🧨 #em #emergencymedicine #cardiology #medtwitter

@khellox @ashaukat09 @DrAmirKaki @ShariqShamimMD @agtruesdell @HadyLichaaMD @Umair2017 14 Fr Manta as long as good stick and healthy artery, very fast and reliable.

@ashaukat09 @DrAmirKaki @ShariqShamimMD @agtruesdell @HadyLichaaMD @Umair2017 Compression

What’s your strategy for Impella removal if there’s no pre-closure? @DrAmirKaki @ShariqShamimMD @agtruesdell @HadyLichaaMD @Umair2017

@agtruesdell Manta also works well for post close

1/2 Impella removal when no Pre-Close (which is preferred) performed. #RadialFirst iliac balloon🎈occlusion (with wire into SFA). Wire into Ao via Impella rewire port. Replace Impella with 10 Fr sheath and place second wire into Ao: Perclose (post-close) over each wire…

@EstherSHKimMD @DermotPhelanMD @VUMC_heart @VUMChealth @garosemd @SanjeevGulatiMD @troyleomd @HadleyWilsonMD @theSHVI Congrats! Great to work with you again.

A msg for my patients. I will be the inaugural Director of the Center for Women's CV Health at Sanger HVI in Charlotte, NC. Thank you @VUMC_heart @VUMChealth for 6 amazing years. 10/1, I get to work w @garosemd @sanjeevgulatiMD @troyleomd @DermotPhelanMD @HadleyWilsonMD @theSHVI

@uroojmd1 Leave the ostial disease, just fix the distal lesion, ESRD patients do terribly with stents, minimize length and make sure it’s optimized

@jedicath @AIU_Medical @omar Feels like every time I pull a Mongo to knuckle it just crosses true

magic with the @AIU_Medical Gladius Mongo. 3 hours with failed AWE, attempts at retro and then when preparing ADR the Mongo just reached distal true lumen! #EuroCTO @omar

@DrMoritzWvB @djc795 @mirvatalasnag @PinakShahMD @mmamas1973 CABG/PCI trials mostly in SIHD, PCI culprit then staged PCI for CR if possible, If not, staged CABG or med therapy.

With current meds, what’s the evidence for the following strategy: #STEMI =>diagnostic cath: MVD => #POBA/DCB of culprit lesion, TIMI3 (no stenting) => elective #CABG. What’s the correct AP/anticoag & timing of CABG (evidence)? @djc795 @mirvatalasnag @PinakShahMD @mmamas1973

Atrium Health Sanger Heart & Vascular Institute completes more than 2,000 TAVR procedures atriumhealth.org/dailydose/2022… #SHVI @jgschwartzmd @troyleomd @SanjeevGulatiMD @AtriumHealth

@sanjayvdesai True legend!

#OslerPride at a uniquely legendary level. Forever grateful.

@kerrigjl Any good data that radials are really good conduits anyway?

Discussing with one of our excellent cardiac surgeons. Went #RadialFirst for diagnostic cath, found 3vCAD. Asked that she use right RA to preserve the left for future cath d/t LIMA. But used traditional radial, so the decision was no... Asked would she if distal radial. Any data?

@aspergian1 Watchdog on back order too. Merritt phD is passable. Really hoping we don't run out of those.

With the CoPilot on back order, I have gotten several ?s about alternatives. We love the BSCI Watchdog as it has the largest ID 0.105". We cram a lot of gear through a hemostatic valve during CHiP/CTO. In review, the Merit PhD specs show it to be very similar to the CoPilot

@thomascassmann @AnkurKalraMD @aspergian1 @AntoniousAttall @RMSSAA @agtruesdell @ahmedknhi @yourheartdoc1 @drandrewsharp @adnanalkhouli Even if optimized stent patency is awful in CKD and ESRD patients, CABG now or CABG later when the stents go down

63-year-old-👩🏾 , CKD no dialysys (creat 3.2), hypertension, diabetes. Chest pain this morning, Wellens Syndrome ecg pattern. What would be your approach? @AnkurKalraMD @aspergian1 @AntoniousAttall @RMSSAA @agtruesdell @ahmedknhi @yourheartdoc1 @drandrewsharp @adnanalkhouli

@AntoniousAttall @Almanfi_Cardio @TAVRBot @ekgpdx @mirvatalasnag Placement isn't any easier than just doing a 5076, fairly reliable fixation but need to make sure you get it far enough towards the RV apex.

Interested in trying the tempo wire for TAVR…what’s been your experience? @Almanfi_Cardio @TAVRBot @ekgpdx @mirvatalasnag

@RajTayalMD @DrAmirKaki @ThomDahle @ekgpdx @bkolskk @DrTomWaggoner @RajanPatelMD @agtruesdell @matheenkhuddus @duanepinto @camppci .035 wire works fine too

For those not familiar with it, here’s a quick, easy way to maintain arterial access with use of a collagen based vascular closure device. Just re-insert a 0.018 micropuncture access wire into the sheath prior to deployment #safefemoral the

@RohanKalMD @nyalborgesmd @SandeepNathanMD @SVRaoMD @KhalilIbrahimMD Agree with that, I probably would have made an attempt and if I got a guide in would have proceeded, but maybe regretted it later!

@nyalborgesmd @THillMD @SandeepNathanMD @SVRaoMD @KhalilIbrahimMD Absolutely, the EBU sat nicely and would have used guide extension if needed. Thankfully, the patient didn’t need intervention

Adventures in #RadialFirst #CardioTwitter 🕷@SandeepNathanMD @SVRaoMD @nyalborgesmd @KhalilIbrahimMD