Sandeep M Patel, M.D.

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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
544 Takip Edilen1K Takipçiler
Sandeep M Patel, M.D.
Sandeep M Patel, M.D.@SMPatelMD·
@djc795 Nothing possible Terrible ostial carotid disease bilaterally, severe iliacs, and LIMA came of left subclavian (LAD CTO) which was on smaller side, and lead pipe aorta all the way through the iliacs
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Sandeep M Patel, M.D.
Sandeep M Patel, M.D.@SMPatelMD·
Yes TC TAVR is fantastic, but never forget the original Cribier access —still necessary and efficient (with Snare) — #Back2theFuture
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Sandeep M Patel, M.D.
Sandeep M Patel, M.D.@SMPatelMD·
@hvanspall Your courage to write this is incredible I can only imagine the tears between drafts and the walk aways from the paragraphs —I was completely shaken and I believe it would happen to us even with the power to help our Loved ones…prayers for u
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Harriette Van Spall, MD MPH 🇨🇦
Harriette Van Spall, MD MPH 🇨🇦@hvanspall·
He was a mentor But departing from evidence, he had my dad w new angina wait 4wks for CABG: Cath/IVUS had shown 70% LM, tight ostial LAD+LCx lesions, RCA occlusion My beloved dad died before CABG The ensuing silence left me w #lessons I carry everyday1/ acpjournals.org/doi/abs/10.732…
Harriette Van Spall, MD MPH 🇨🇦 tweet media
Subodh Verma@SubodhVermaMD

So much fun, interviewing, Dr. David Latter on his incredible journey over four decades as a heart surgeon, lessons learned and words of wisdom for the future generation. The full video will be posted soon.

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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
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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.
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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
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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.
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John T. Saxon, MD
John T. Saxon, MD@jtsaxon·
We have made a massive mistake. 🧵
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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
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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.…

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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.
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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!?!

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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?
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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
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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

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@djc795 @GaneshMuthappan @SCAI @GuiAttizzaniMD @DrArgyle @PedroMDMSc @GilbertTangMD @DrJayMohan