Jeffrey Rossi

@AdamGreenbaumMD @drmomani @CathElectroSurg @IsidaByku @chetanhuded @MSummersMD Looks nice. What guides do you have in there? Do you just pull back on both catheters (i.e. how do you get the aortic part of the flying V to move posterior with the guide through Agilis?)

@drmomani @jrossimd @CathElectroSurg @IsidaByku @chetanhuded @MSummersMD Here’s the LAO view to better see the LVOT and valve post relationship to it.

Attempting an antegrade LAMPOON case. Anyone know how you get 2 Agilis through the same puncture? Also what guides go through each Agilis catheter. Any other equipment recs? @AdamGreenbaumMD @CathElectroSurg @IsidaByku @chetanhuded

@THillMD @CleveClinicCath @SamHorrMD @ProtectedPCI @J_M_McCabe @JayMathewsMD @MSummersMD @InvasiveCardiol @doctor_hansen @chetanhuded We left in for 2 more days, no reperfusion sheath, no arm issues

@jrossimd @CleveClinicCath @SamHorrMD @ProtectedPCI @J_M_McCabe @JayMathewsMD @MSummersMD @InvasiveCardiol @doctor_hansen @chetanhuded Interesting case, did you take it out? Was there enough flow or did the arm get ischemic?

Patient with no femoral access, severe ostial left subclavian disease, EF 20%, needs MV/LM PCI. Is this right subclavian too tortuous for axillary impella? @ProtectedPCI #cardiotwitter @CleveClinicCath

Are you performing unilateral access for #TAVR? @CleveClinicCath we are almost exclusively unilateral access (TAVR sheath, 5Fr inferior arterial and 6Fr femoral vein) #cardiotwitter #radialfirst #TMVR. What is the advantage of contralateral access in your opinion?

@AdamGreenbaumMD @CathElectroSurg @IsidaByku @chetanhuded @MSummersMD @rstsutsui @tavrkapadia @PaulMahoneyMD @CleveClinicCath @SergeHarbMD @GrantReedMD @JayMathewsMD @nyalborgesmd @doctor_hansen @NagarajaVinayak @CCFcards @StephenKiddMD1 #TAVR @SamHorrMD

@AdamGreenbaumMD @CathElectroSurg @IsidaByku @chetanhuded @MSummersMD @chetanhuded @rstsutsui @tavrkapadia @PaulMahoneyMD @CleveClinicCath @SergeHarbMD @GrantReedMD @JayMathewsMD #cardiotwitter #TMVR #ViV #LAMPOON @nyalborgesmd @doctor_hansen @NagarajaVinayak @CCFcards @StephenKiddMD1

@DrMauricioCohen @SVRaoMD @Radial_ICG @GBaqueroMD @CamiloGomezMD1 @CarlosAlfonsoMD @UMJMHCardiology @UMiamiHealth @rajivxgulati What do you do if you need covered stent?

This is an important additional step to increase the safety of TAVR. I have been using #RadialFirst as secondary access for #TAVR for more than 6-7 years. @SVRaoMD @Radial_ICG @GBaqueroMD @CamiloGomezMD1 @CarlosAlfonsoMD @UMJMHCardiology @UMiamiHealth @rajivxgulati

@MinhNVoMD How did you do that ... is that tape? @rstsutsui

Single access with Destination sheath, hubbed guide but unable to reach coronary. We decided to shortened guide. Any other solutions

@SamHorrMD @ProtectedPCI @CleveClinicCath @J_M_McCabe @JayMathewsMD @MSummersMD @THillMD @InvasiveCardiol @doctor_hansen @chetanhuded @rstsutsui @chetanhuded @ProtectedPCI @RajTayalMD @KAlaswadMD @CleveClinicCath @MSummersMD @THillMD @nyalborgesmd #PercAx #cardiotwitter

@SamHorrMD @ProtectedPCI @CleveClinicCath @J_M_McCabe @JayMathewsMD @MSummersMD @THillMD @InvasiveCardiol @doctor_hansen @chetanhuded see this video of a patient where we left impella in left arm, impella and sheath were occlusive but clear collateral filling of left axillary

@Bcherry20 @verin2 Better call gonzo for some “advice”

Big day at home. @verin2 heads To 24 hour call and I am with my son @jackiecherry23 - it’s me vs the beast

@sbh0012 @PhilGenereuxMD @CMichaelGibson @ajaykirtane @ErinMichos @Allison_Dupont @chipkaminsky @Faicel_MD @GruentzigG @aymanka @MountSinaiHeart @WomenAs1 @mirvatalasnag @Selkrish98 @SonaliInamdar21 @karankarkera03 @CleveClinicCath we def forget to do this routinely but should

@KAlaswadMD @ProtectedPCI @CleveClinicCath @J_M_McCabe Also do you worry about covering right carotid if you use long sheath?

@jrossimd @ProtectedPCI @CleveClinicCath @J_M_McCabe Use 23 cm Impella CP sheath instead of the short sheath. To prevent the CP cage from dissecting the SC A. Or use transcaval access

@KAlaswadMD @ProtectedPCI @CleveClinicCath @J_M_McCabe Can you leave a transcaval Impella in post procedure if patient can’t be weaned after pci?

@RajTayalMD @ProtectedPCI @CleveClinicCath @J_M_McCabe @ShockwaveIVL We've done that in past, have had some issues with significant vagal response/bradycardia while ballooning ... anyone else experience that?

@jrossimd @ProtectedPCI @CleveClinicCath @J_M_McCabe It’s hard to see but it seems like it may be. You can always put an 0.018 wire across it to see how much it straightens out, alternatively @J_M_McCabe has used @ShockwaveIVL to treat ostial LSCA dz prior to doing a left #PercAx which is another option in that situation

@SamHorrMD @ProtectedPCI @CleveClinicCath @J_M_McCabe @JayMathewsMD @MSummersMD @THillMD @InvasiveCardiol @doctor_hansen @chetanhuded Subclavian CPR

@SamHorrMD @ProtectedPCI @CleveClinicCath @J_M_McCabe @JayMathewsMD @MSummersMD @THillMD @InvasiveCardiol @doctor_hansen @chetanhuded Iliofemoral Anatomy