Sandeep M Patel, M.D.

744 posts

Sandeep M Patel, M.D. banner
Sandeep M Patel, M.D.

Sandeep M Patel, M.D.

@SMPatelMD

Father, Husband, Son, Brother, Grandson, Interventional Cardiologist; Director, Structural Heart & Interventional Center, St. Rita’s, Lima,OH; Tweets are My Own

Lima, OH Katılım Temmuz 2020
542 Takip Edilen1K Takipçiler
Sandeep M Patel, M.D.
Sandeep M Patel, M.D.@SMPatelMD·
@achdDoc12 100% right—severe acute Mr, acute on chronic chf, LV decompression, AS shock, stemi with no reflow—it works it always has and you don’t have limb ischemia or bleeding; but u gotta manage within 24-48 hrs, and later ur gonna need big MCS to reverse the MODS
English
1
0
3
224
Anurag Sahu
Anurag Sahu@achdDoc12·
The IABP isn’t perfect. It’s not Impella. It’s not ECMO. But it still helps a lot of patients when used thoughtfully. Timing, positioning, augmentation, weaning. There is art to IABP management. And that skill still matters, even in the era of shiny mechanical support devices.
Anurag Sahu tweet media
English
8
22
105
12.2K
Sandeep M Patel, M.D.
Sandeep M Patel, M.D.@SMPatelMD·
@JayMathewsMD @jtsaxon Ok hold up…I thought.. Cataclysmic = torrentialTR + solar eclipse Biblical=torrentialTR+mayan calendar End of world date Extinction =I hear we won’t see in our lifetime, or yet to be discovered with current tech I was sure there was a footnote during a course at a conference
English
1
0
1
69
Jay Mathews MD, MS, FACC, FSCAI
Jay Mathews MD, MS, FACC, FSCAI@JayMathewsMD·
@jtsaxon I hate these scales. Just give me a consistent numerical scale and stop with the dramatic descriptors that have questionable clinical relevance. I can deal with 5+ over "catastrophic" or "cataclysmic" "epic" "biblical" "generational" "devastating" "extinction-level" TR.
English
1
0
8
239
John T. Saxon, MD
John T. Saxon, MD@jtsaxon·
We have made a massive mistake. 🧵
English
9
8
38
12.9K
Gui Attizzani
Gui Attizzani@GuiAttizzaniMD·
Grateful to God, to our resilient Structural Heart Team and to @shishem for this fantastic recognition. We largely expanded in the last 11 years to >500 #TAVR, >100MTEER, >500 LAAO performed per year, Tricuspid, multiple trials, trainees and 3 hospitals. @ACUkaigweMD @vinesteves
Gui Attizzani tweet media
English
10
6
45
5.1K
Dr. Kevin Buda
Dr. Kevin Buda@DrKevinBuda·
Feeling the pressure to understand ECMO hemodynamics? Join me and the great and powerful @JasonKatzMD as we unload the controversy and fill you in on filling pressures! 🫀🫁🩸 RVSP ⬇️ @CCCEnthusiasts @BalimSenmanMD @dpot29 @AmandaGarfinkel @MayoClinicCCM @MayoPCCM @SMPatelMD @Gumadat1 @ElliottMillerMD @garimadahiyamd @AndreaElliottUM
CCC Enthusiasts@CCCEnthusiasts

JOIN US - DECEMBER JOURNAL CLUB! 🗓️Thu, 12/4 ⏰5pm ET 🔗bit.ly/3LFD7CI 📰PAPO-Flow Study - Effect of ECMO Flow Variations on Pulmonary Capillary Wedge Pressure in Patients with Cardiogenic Shock. We are very excited to discuss this paper with SoCCC President, @JasonKatzMD from NYU Langone Health and Cardiology Fellow, @DrKevinBuda from Minneapolis Heart Institute and Hennepin Healthcare. They will offer their perspectives on the study results and address questions. Article located here: jacc.org/doi/10.1016/j.…

English
1
4
14
1.8K
Dr. Kevin Buda
Dr. Kevin Buda@DrKevinBuda·
Some of these looked at flow over time, not just initially. I 100% agree that I wish there were more granular data. It is helpful to know that ECMO does not routinely increase LV filling pressure or volume in a flow-dependent manner, even in people with shock or LV dysfunction. But that does not answer the question of what to do when the patient in front of you has a pulse pressure of <10, LV distension, or reduced AV opening on ultrasound.
English
1
0
1
37
Dr. Kevin Buda
Dr. Kevin Buda@DrKevinBuda·
Good question @SMPatelMD! I'll try to answer with data rather than anecdote: 1⃣ A single-center interventional study increased V-A ECMO flow from 2 to 4 L/min in 0.5L/min increments. PCWP decreased in 36%, remained stable in 58%, and increased in only 6%. 👉The median LVEF was <20% and all patients were in cardiogenic shock. 🔑 94% of patients on V-A ECMO for cardiogenic shock had stable or decreasing LV filling pressures with higher ECMO flow. Notably, 64% of patients had IABP, so this wasn't a pure ECMO without unloading study. ➡️jacc.org/doi/10.1016/j.… @CharlesJuvin @Glebparis @CombesProf
Sandeep M Patel, M.D.@SMPatelMD

@dpot29 @CCCEnthusiasts @SocietyOfCCC @DrKevinBuda @aniket_rali @JasonKatzMD @TrinaAugustinMD This can only be true if the LV function was relatively normal —in a failing LV (the reason for the ECMO), almost always the aortic valve stops moving bc LV cannot pump against 4-5LPM of retro flow…am I missing something—hence need to decompress!?!

English
1
0
2
218
Sandeep M Patel, M.D.
Sandeep M Patel, M.D.@SMPatelMD·
@DrKevinBuda Thanks for an awesome answer—I’ve read some of these b4 while the numbers drop, the lack of aoV excursion once you put them on determines many a time if we should unload bc these numbers evolve during the course of the run; perhaps if initially there was pulsatility?
English
1
0
1
25
Dr. Kevin Buda
Dr. Kevin Buda@DrKevinBuda·
2⃣ This study of patients with SCAI D (25%) and SCAI E (75%) cardiogenic shock similarly evaluated 3D LVEF & invasive LVEDP as a function of ECMO flows. 👉The baseline LVEF was similarly 20% 🔑The highest ECMO flows significantly reduced LVEDP, LVEDV, and LV stroke work. Notably, these patients did not have other unloading strategies. ➡️onlinelibrary.wiley.com/doi/full/10.10… @kosmopolitanMD @AndreaElliottUM @RanjitJohnMD @BurkhoffMd
English
2
0
0
44
Deepika Potarazu, MD
Deepika Potarazu, MD@dpot29·
I love the discourse around this lately! Is the phenomenon of LV unloading via reduction in transpulmonary flow based on ECMO flow rate? Is there a sweet spot? @CCCEnthusiasts @SocietyOfCCC @DrKevinBuda What do you think @aniket_rali, @JasonKatzMD @TrinaAugustinMD
Dr. Kevin Buda@DrKevinBuda

🚨Can V-A ECMO unload?🚨 Our recent📰 in @JCardFail 👉authors.elsevier.com/a/1m53v3pkRzlS… ✅ Venous drainage ↓ transpulmonary flow → ↓ LV preload ✅ Often ↓ inotropes/pressors → ↓ myocardial O₂ demand ✅ Human data show reduced LV filling pressures & stroke work at higher flows 💡 Are we overestimating the afterload penalty of ECMO in cardiogenic shock? Ideas & critiques welcome! #CardioTwitter #ECMO #CardiacCriticalCare #CardiogenicShock #FOAMcc #MedEd @MayoClinicCCM @MayoClinic @dpot29

English
1
0
7
2.6K
Sandeep M Patel, M.D.
Sandeep M Patel, M.D.@SMPatelMD·
SOLO-CLOSE 200! Watchman NEAT (hold the ICE) with 1 operator in 30 min or less, use TEE, no anesthesia, home same day, positive contrib margin, do it any day don’t worry about scheduling! It’s possible—we will show you how! StRitas, Lima, Ohio. @SCAI @crfheart @ACCinTouch
Sandeep M Patel, M.D. tweet mediaSandeep M Patel, M.D. tweet mediaSandeep M Patel, M.D. tweet media
English
3
3
22
2.3K

Keşfet

@st @MDT_Cardiac @AbbottCardio @WLGore @InariMedical @PenVascular @BSCCardiology @achdDoc12