Today I finally used my extensive training in the Krebs cycle from undergrad and medical school to diagnose and treat a patient.
Just kidding. I rounded and did some caths.
@SaidAshrafMD@SVRaoMD You get much better pictures with a pigtail. It’s designed to dissipate the pressure equally and not whip wildly around the LV during injection. Agree, myocardial entrapment is rare, but mostly preventable with a pigtail.
@SVRaoMD Performing a high pressure LVgram with an end hole catheter is done for one of two reasons, ignorance or laziness. Neither are becoming of a professional. It takes 30 seconds to change to a pigtail.
@HeartOTXHeartMD I thought it was ironic that the same journal that taught many, if not most of us, critical appraisal of scientific medical literature would publish something so obviously confounded.
@jamiemccabeMD Fascinating. Minimal TAVR becoming more minimal all the time. If post TAVR CHB can be reliably predicted, routine same day DC on the horizon.
@tristonsmithmd@SVRaoMD@rwyeh@djc795@bnallamo@CMichaelGibson Agree 100%. Interventional Cardiology/CMS has a gate keeping problem.
Was encouraged to see the most recent TTVR CMS NCD not mention volumes. Hopefully this is a trend.
Strict volume requirements do limit rural access as well as limit where physicians can live and practice.
@PradeepYadavMD@djc795@CMSGov@SCAI@ACCinTouch Honest question here because this is a new commercially available technology - how do new sites have any experience in TTVR if they were part of the clinical trials? Should this be limited only to sites that were in the trial? Does 50 vs 150 TAVR/yr make one better at TTVR?
@djc795@PradeepYadavMD@CMSGov@SCAI@ACCinTouch David, I have absolutely no insight into that, but would hope that this suggests a new emphasis on outcomes and demonstrated expertise where before volume (of other partially related procedures) served as a surrogate. Do you have any insight here?