Ming Guo

Cardiac surgeon @HeartInstitute

[Dr. Gilbert Tang @GilbertTangMD]

Interesting Evolut low risk #TAVR 6y data just out @JACCJournals . While there were ⬆️ reintervention in TAVR over SAVR arm, a deep dive and understanding of bioprosthetic valve material and design, and potential implications should be noted:
- we know bovine pericardial valves in SAVR and now TAVR fail primarily by stenosis not regurgitation. In SAVR, porcine valves fail mostly due to AR while bovine pericardial valves fail due to AS. This was shown in PARTNER3 low risk where there were more thrombosis in TAVR but not higher reintervention in TAVR, likely bc failure mode was AS and progressive prosthetic AS is quite well tolerated
- porcine pericardial valves may fail via a different mechanism. EV failure here appeared primarily due to commissural tear similar to what we see in porcine SAV surgically. This AR from failed EV appeared to be due to large non compliant balloon post dilatation to ⬇️PVL, since the waist of EV is < inflow where it seals against the annulus. As a result, the waist of the EV would’ve stretched beyond its nominal frame dimensions (eg a 24mm waist stretched to 28mm using a 28mm non compliant or even semi compliant balloon against an annulus of 28mm). This may risk leaflet or commissural damage. We now have strict IFU from @MDT_StructHeart on non compliant post dilatation sizes to mitigate against this potential issue. We know acute AR is poorly tolerated so these pts really had no option other than reintervention on the failed TAVR. This also highlights the importance of choosing the right anatomy for TAVR to avoid aggressive post dilatation to ⬇️PVL. Obviously we need to minimize PVL in TAVR but if mild or greater PVL is expected, SAVR should remain a durable alternative in low risk pts, where we’ve seen even mild PVL in real world TVT registry with S3 can ⬆️☠️ although P3 7y didn’t show this.
- other self expanding TAV designs different from EV may not be susceptible to this issue in terms of non compliant balloon post dilatation damage to the leaflets. Long term data will shed light on this
- in this context we also need to question about balloon valve fracture post TAV-in-SAV using a non compliant balloon inflated to high pressure potentially beyond the waist of EV that may risk leaflet damage. Pre fracture even though risking acute AR and one can control pace to unload the LV, may be safer and avoid leaflet damage
- given we now have 3 commercially available TAV, 2 of which are approved for low/intermediate risk pts, catering the valve choice to the specific pt anatomy and considering clinical, demographic and social factors altogether to offer the best therapy to our pts, is key to optimize durability and lifetime management. Optimizing index TAVR is now more critical than ever, and SAVR in hostile TAVR anatomy in low or even intermediate risk pts (ie avoid unsafe TAVR) should remain in our ❤️team discussions and recommendations

[The Cultural Tutor @culturaltutor]

A brief introduction to Albert Bierstadt, one of the greatest landscape painters who ever lived...

[Andrew Ng @AndrewYNg]

1/ Thrilled to announce: Our new course ChatGPT Prompt Engineering for Developers, created together with @OpenAI, is available now for free! Access it here: https://t.co/OaIpa6L2jn

[Ming Guo @mingdguo]

@benhibbertMDPhD @CircAHA @sdparlow @DiSantoPietro Congratulations!!! Witnessed the hard work of @DiSantoPietro and @sdparlow first hand!!

[Ming Guo @mingdguo]

@ottawaheartrob

[JAMA Surgery @JAMASurgery]

More familiar surgeon-anesthesiologist dyads can yield better outcomes for complex GI surgery: each surgery done together is associated with 5% lower odds of morbidity for the next patient. @HalletJulie @DrTonyEskander @propelresearch https://t.co/eKHYnyrGAg

[Benjamin Carlson @bfcarlson]

In 1974, author Ray Bradbury was asked, “What is space travel going to do for man?” In response, he gave the most mystical, mind-blowing, and strangely moving answer I could have imagined.

[Ming Guo @mingdguo]

@EricTopol @Nature @ottawaheartrob

[Ming Guo @mingdguo]

@thaiscoutinhoCV @MayoClinicCV @HeartInstitute @CWHHC Huge loss for UOHI… but best of luck!! :)

[Pixar @Pixar]

She’s Ember 🔥. He’s Wade💧. Welcome to Element City.

Watch the new trailer for Disney and Pixar’s #Elemental and see the movie in June 2023!

[Siddhartha Mukherjee @DrSidMukherjee]

And another excerpt:
https://t.co/cxOlZUOYls

[Ming Guo @mingdguo]

@ottawaheartrob @drlauraduggan Yes!!!

[Dr. Glaucomflecken @DGlaucomflecken]

It’s amazing, the heart has to do one thing, just one thing, and still manages to fuck it up. The brain does like a thousand things. Even the penis does 2 things. No excuses.

[Massimo @Rainmaker1973]

This Japanese technique to fold shirts in 2 seconds seems to find a secret topology hidden inside clothes

[full video, HD, DaveHax: https://t.co/0oeSpfnWPl]

[Matt Lieberman @social_brains]

Just finished @anilkseth's "Theories of Consciousness" Nature Reviews Neuroscience paper. Fantastic introduction to the main neural theories of consciousness. I am developing a new course and structuring an entire lecture around this paper https://t.co/GjCITom0Nc

[Frank Harrell @f2harrell]

Regression Modeling Strategies course notes have been significantly expanded, updated, and converted into a free #quarto e-book at https://t.co/WvS8ORfetx #rmscourse @vandy_biostat @VUDataScience #RStats @quarto_pub @EdgeforScholars #Statistics

[C. Michael Gibson MD @CMichaelGibson]

REVIVED trial: In pts with severe ischemic LV systolic dysfunction (EF ≤ 35%) and viable myocardium on imaging, PCI did not reduce composite incidence of all-cause death or HHF at median of 3.4 yrs compared to optimal medical therapy (OMT) #esc2022 #ESCCongress

[Vala Afshar @ValaAfshar]

You can go to school and spend years trying to learn about great marketing.

Or you can spend a few minutes watching Steve Jobs - all marketers should listen:

[Xander Steenbrugge @xsteenbrugge]

"Voyage through Time"
is my first artpiece using #stablediffusion and I am blown away with the possibilities...

We're crossing a threshold where generative AI is no longer just about novel aesthetics, but evolving into an amazing tool to build powerful, human-centered narratives

[Abs @DrAbs2024]

Are we actually graduating competent surgeons? Do we spend too much time focusing on a written RCPSC exam, where is the exam that assess whether a trainee can operate proficiently? Will the change to CBD be enough?

https://t.co/JnErTaNOJ8