Phillip Smith

As a structural intervention faculty at @uabmedicine , education of fellows is one of my favorite parts of the job. Having recently completed fellowship with @PhillipASmithMD under the mentorship of @MustafaAhmedMD at UAB one of the key points was that we never want to do things the same every year and we should always question why or how we do the things when it comes to workflow. When learning transseptal puncture we alternate between standard needle and radiofrequency needle without obvious reason. We had not made the full jump at UAB to the radiofrequency needle at this point. We decided to help answer our question through data to influence our practice. During my fellowship we conducted a study to collect this data and outline our experience. The findings were as follows. 87 patients evaluated, all comers of transseptal procedures (LAAO, mitral TEER and ViV, mitral PVL and PBMV). Our data showed shorter procedure times for both crossing transseptal (204 seconds vs 282 seconds) and sheath placement (82 seconds vs 124 seconds) with the radiofrequency needle. Attending involvement was significantly less with the radiofrequency needle (28% vs 7%). Importantly, there was exceptional safety and no adverse events. Here in the Department of Interventional and structural cardiology at UAB, our main priority is to advance patient care safely while fostering trainee development and contributing data to advance technical proficiency. longdom.org/open-access/ef… @MouhamedAmr1 @HassanAlkhawam @AshleyReed_RT @Dr_AbuDaya @dprime45 @DocEBROhimi @MadhuraMyla @MarkLaw80307275 @GarimaAroraMD @pannvar @KyleEudaileyMD @RaeganWhite6 @Katie_Evatt @Skmcelwee @RootGal210

1/10) Can MitraClip work in a cleft? #UABStructural @MustafaAhmedMD @GarimaAroraMD Superstar structural fellows @MadhuraMyla @DocEBROhimi Technical support @AshleyReed_RT

Using AI fusion tools to crack the code on making lesion localization intuitive. Fellows:@DocEBROhimi @MadhuraMyla "how do we know where to wire the PVL?" Answer: "Here you go, wire the red dot where the leak is"

@MustafaAhmedMD Yeah this lab is a structuralist’s and advanced imager’s playground. Can’t wait to see the next iteration of this.

Complex simplification of structural heart with Echo fusion and AI. Within a few years will be Holo lens and 4D with depth perception. Here's a recent example from my lab where the workflow is routine, this is part of what we see on screen during the procedure. #UABStructural

Welcomed the new year at @STVHealth with a ECMO Thrombectomy case of a massive PE presenting peri-arrest, lactic 10, maxed out on all pressors. Had to act immediately. Alongside @HassanAlkhawam efficient procedure and incredibly discharged on POD4. Great skills learned with the PERT team, @Skmcelwee @MustafaAhmedMD who was pivotal in developing such a streamlined infrastructure to help even the sickest and complex of patients.

Pumped to resume the 2nd half of my Advanced Interventional/#UABStructuralHeart Fellowship with my co-fellows @MadhuraMyla @AHMEDASUBAHI. To kick off 2024, here is a compilation of cases from our last day in 2023 with a 🧵of tips/tricks and learning points below! Enjoy!

(1/22) “PE Thrombectomy Tweetorial”: How we do it! #UABPERT #UABStructural @MustafaAhmedMD @MouhamedAmr1 @BaranAksutMD @Skmcelwee @Dr_AbuDaya @dprime45 @DocEBROhimi @AHMEDASUBAHI @PhillipASmithMD

Nice teaching TAVR. Degenerated 23mm CE valve. Predominant AI. Should be an easy case?! Very difficult to cross with valve even after upgrade to Lunderquist. Attempts to deploy valve resulted in exaggerated LV displacement despite pulling valve and pushing wire.

Great lessons from @MustafaAhmedMD as he gives a great lecture on functional testing for INOCA. @UABCardiology @UABCVI @UABHeersink

3 months into #UABstructural fellowship, best decision of my life! With cofellows @DocEBROhimi & @AHMEDASUBAHI, >330 wide variety of cases under extraordinary mentorship of @MustafaAhmedMD & also @MouhamedAmr1 & @MarkLaw80307275. Learning a lot & here's a brief video to share!

Loved the hands-on experience! Thank you @MustafaAhmedMD @GarimaAroraMD. @MouhamedAmr1 @DocEBROhimi @AHMEDASUBAHI @RaeganWhite6 @Dr_AbuDaya @dprime45 @AshleyReed_RT @PhillipASmithMD @Katie_Evatt @BaranAksutMD @HassanAlkhawam @TEWatts3 @ShanePrejeanMD @_C9_H13_NO3 @nnishank52

One last project from my fellowship. Basic Rotational atherectomy Tweetorial. Our approach to device prep and use. #UABSTRUCTURAL @MustafaAhmedMD , @MouhamedAmr1 , @BaranAksutMD , @PhillipASmithMD , @DocEBROhimi , @MadhuraMyla

Mitraclip Tweetorial Pt.2. Optimizing a perpendicular grasp. Getting off the aorta. I use this advanced steering technique in most Mitraclip cases. A perpendicular grasp allows for even bileaflet insertion without tension and clip canting on release.🧵 1/6 #UABStructural

Basic Mitraclip Steering Tweetorial. Device View. (1/6) for fellows and whoever! Let's Start with M Knob. After the clip is advanced in to the LA, this is the typical maneuver to steer down to the valve. #UABStructural

@MustafaAhmedMD teases out the lifetime decision making processes for pts with #structuralheart dz -it takes a #heartteam approach! One size doesn’t fit all-patients don’t always fit in neat categories. @UABCardiology

An unusual case of a 23 yo patient (non complaint) with severe TR from MVC (due to pap muscle rupture). Repair with neocords x 2, commissuroplasty x 2, band annuloplasty. No TR at the end, Gm-2mm Hg. Repair! whenever possible. @UABCVI @UABSurgery @UABCardiology @uabmedicine

1/12) Left pulmonary artery stenting after subacute occlusion. #UABStructural @MustafaAhmedMD @MarkLaw80307275 @KyleEudaileyMD @BaranAksutMD @PhillipASmithMD @RootGal210

I'm always interested at the unique nature of how PE presents. In this case hypoxemia with large oxygen requirement was predominant and persistent despite initial AC therapy. This resolved almost immediately on Thrombus aspiration @MustafaAhmedMD @PhillipASmithMD @BaranAksutMD

Distal Perfusion catheter placement Tweetorial #UABStructural @MustafaAhmed , @Mouhamedamr1, @BaranAksutMD , @PhillipASmithMD , @MadhuraMyla @DocEBROhimi