Grand Rounds | 2021-2022

Hani Jneid, MD
Associate Professor of Medicine
Baylor College of Medicine
Director, Interventional Cardiology Fellowship Program
Director, Interventional Cardiology Research
Baylor College of Medicine
Director, Interventional Cardiology
The Michael E. DeBakey VA Medical Center
Director, Structural Heart Disease
Ben Taub Hospital

Overview:
Provide an overview to Clinicians (case-based) about the diagnosis and management of AS from the ACC/AHA VHD Guidelines. To provide the clinicians with the perspectives of the American Guidelines pertinent to the treatment of AS and the recent recommendations related to TAVI and SAVR, and contrast them w the recently published ESC guidelines.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Cite recommendations related to TAVI and SAVR, and contrast them w the recently published ESC guidelines
2. Summarize the indications and choices of treatment for AS, including TAVI and SAVR
3. Distinguish between the American and European Perspectives for the treatment of AS

Disclosures:
Hani Jneid, MD has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant relationships have been mitigated.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Educational Grants
This continuing medical education activity has been supported in part by educational grants from the following company:

Edwards Lifesciences, LLC

Raymond Stainback, MD, FASE
Medical Director, Non-Invasive Cardiology,
Texas Heart Institute, CHI St. Luke’s Health – Baylor St. Luke’s Medical Center;
Associate Professor of Medicine,
Baylor College of Medicine;
Cardiologist, Hall-Garcia Cardiology at Baylor College of Medicine,
Past-president, GHSEV;
President, ASE

Overview:
We will briefly explore the history clinical guidelines recommendations for noninvasive imaging assessment in patients with suspected and established coronary artery disease. We will then cover key concepts of two new 2021 recommendations to better choosing the best test in patients with coronary syndromes, acute or chronic.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Use concepts of Baysian analysis of pretest probability of disease to guide management
2. Better differentiate cardiac from non-cardiac chest pains (which reads no testing)
3. Apply new concepts for ischemia no obstructive coronary arteries (INOCA)

Disclosures:
Raymond Stainback, MD has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Mehdi Razavi, MD
Director, Electrophysiology Clinical Research & Innovations
Teaching Staff, Cardiovascular Disease Fellowship
Editorial Consultant, Texas Heart Institute Journal
Teaching Staff, Clinical Cardiac Electrophysiology Fellowship

Overview:
We will discuss medical device innovation and development at THI, with a focus on cardiac electrophysiology.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Review the process involved in medical device development
2. Demonstrate examples of basic concepts being brought to the clinic

Disclosures:
Mehdi Razavi, MD has ownership of Saranas, Maxwell Biomedical, Nanolinea, and XN Health.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Jose L. Diaz-Gomez, MD
Senior Faculty
Cardiovascular Anesthesia and Critical Care Medicine
Baylor College of Medicine
Medical Director
Cardiothoracic, Mechanical Circulatory Support, and Transplant Critical Care
Director, Critical Care Echocardiography
Baylor St. Luke’s Medical Center

Overview:
Critical Care Echocardiography is a recent addition to Point-of-Care Ultrasonography in critical care settings, which comprises all elements of echocardiography with additional elements specific to the care of the critically ill.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Summarize the evidence of the application of critical care echocardiography during the last decade
2. Describe the new national board-certification in critical care echocardiography
3. Examine a must-have research agenda in critical care echocardiography

Disclosures:
Jose L. Diaz-Gomez, MD has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nezar Falluji, MD
System Physician Vice President – Director CommonSpirit Health
Cardiovascular Services Line

Overview:
We will review the emerging trends in Healthcare, the value proposition of patient-centric care delivery, along with an overview of the important role of the physician-leaders in shaping these value strategies and the work that is being done in CommonSpirit Health CV service line.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Discuss the impact and the need to participate in leading change in health care delivery
2. Identify the limitations and complexity of defining value in healthcare
3. Discuss CommonSpirit CVSL physicians lead advancement of quality and financial stewardship

Disclosures:
Nezar Falluji, MD has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Sunil Rao, MD
Professor of Medicine
Duke University Medical Center
Section Chief, Cardiology
Durham Veterans Affairs Medical Center
Durham, North Carolina

Overview:
Dr. Rao will discuss the incidence and associated outcomes of bleeding in ACS patients and strategies to reduce the risk and improve outcomes.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Describe the incidence of bleeding complications among patients undergoing PCI
2. Describe the outcomes associated with bleeding and blood transfusion in patients undergoing PCI
3. Describe ongoing trials examining the optimal transfusion threshold in anemic patients undergoing PCI

Disclosures:
Sunil Rao, MD has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Marc Moon, MD
Chief, Division of Cardiothoracic Surgery
Baylor College of Medicine
Chief, Adult Cardiac Surgery
Texas Heart Institute
Chief, Adult Cardiac Surgery Section
Baylor St. Luke’s Medical Center

Overview:
Dr. Moon will explore the various pathoanatomic changes that occur in the mitral and aortic valve apparatus that can lead to regurgitation. Analysis of pathoanatomic alterations will then be used to determine the most efficient mechanistic approach to repair rather than replace regurgitant valves.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Categorize three types of mitral valve pathology using the Carpentier classification
2. Differentiate mode of aortic regurgitation caused by changes in the valve leaflets versus changes in the functional aortic annulus
3. Describe techniques to repair the mitral and aortic valves

Disclosures:
Marc Moon, MD is a member of the surgical advisory board for Medtronic.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Donald Lloyd-Jones, MD, ScM, FAHA
President, American Heart Association (AHA)
Chair, Department of Preventive Medicine
Eileen M. Foell Professor of Heart Research & Professor of Preventive Medicine
Northwestern University Feinberg School of Medicine

Overview:
Dr. Lloyd-Jones will review the life course of cardiovascular health (as defined by the American Heart Association) and its determinants, mechanisms, correlates, and outcomes, with a particular focus on inter-generational transmission and molecular mechanisms of healthy longevity.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Describe the components and metrics of cardiovascular health (and Life’s Simple 7) and their links to healthy longevity and cardiovascular outcomes.
2. Intervene to measure and improve cardiovascular health in patients and populations

Disclosures:
Donald Lloyd-Jones, MD has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Scott A. LeMaire, MD, FACS, FAHA, FCCP
Professor & Vice-Chair for Research
Michael E. DeBakey Department of Surgery
Professor, Molecular Physiology & Biophysics
Director of Research, Division of Cardiothoracic Surgery
Jimmy & Roberta Howell Professorship in Cardiovascular Surgery
Baylor College of Medicine

Overview:
Dr. LeMaire will describe the clinical and basic science evidence supporting concerns regarding the use of fluoroquinolones in patients at risk for aortic disease, and to provide an update on the current warnings about the aortic risks associated with using these medications.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Describe the newest scientific evidence about the risks of using fluoroquinolones in patients with aortic disease.
2. Explain the latest warnings that have been released by the FDA in the United States and the EMA in the EU.
3. Discuss how to apply these warnings to your clinical practice.

Disclosures:
Scott A. LeMaire, MD is a consultant for Terumo Aortic & Cerus; he is a principal investigator for clinical studies for Terumo Aortic.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Eric E. Roselli, MD
Chief, Adult Cardiac Surgery
Director, Aorta Center
Staff Surgeon
Cleveland Clinic Department of Thoracic & Cardiovascular Surgery
Teaching Faculty
Cleveland Clinic Lerner College of Medicine

Overview:
Aortic care has rapidly evolved over the last two decades and now represents more than one fifth of the cardiovascular operations performed at the Cleveland Clinic. Advances have occurred in understanding the pathophysiology, diagnostic imaging, open hybrid and endovascular treatment, follow-up, and quality of life. Dr. Roselli will discuss these issues as we move towards the delivery of precision care of the aorta.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Demonstrate the natural history of aortic aneurysm and dissection with and without treatment.
2. Assess an individual patient’s risk from aortic disease in terms of clinical characteristics, genetic factors, comorbidities, and treatment options.
3. Summarize the latest developments in hybrid and endovascular therapy of aortic disease.

Disclosures:
Eric Roselli, MD is a consultant for Artivion, Edwards Lifesciences, Medtronic, Terumo Aortic and WL Gore; he is a patient beneficiary for Artivion. Dr. Roselli is a speaker for Artivion, Cook, Edwards Lifesciences, Terumo Aortic and WL Gore; he is also an investigator for Cook, Edwards Lifesciences, Medtronic, Terumo Aortic and WL Gore.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

O.H. Frazier, MD
Co-Director, Center for Preclinical Surgical & Interventional Research
Texas Heart Institute
Former Chief, Transplant Service
CHI Baylor St. Luke’s Medical Center
Professor of Surgery – University of Texas MD Anderson Cancer Center
Tenured Professor, Baylor College of Medicine

Overview:
Dr. O.H. Frazier will review the history, current application, and future of mechanical circulatory support.

Learning Objectives:
At the conclusion of the activity a participant should be able to:

1. Identify the two most important breakthroughs in MCS technology.
2. Identify current limitations of MCS technology.
3. Recognize future goals of the technology.

Disclosures:
O.H. Frazier, MD has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation and Credit Designation
Texas Heart Institute is accredited by the Accreditation Council or Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Texas Heart Institute designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Peter Hotez, MD, PhD
Dean for the National School of Tropical Medicine
Professor, Dept of Pediatrics & Molecular Virology & Microbiology
Baylor College of Medicine
Endowed Chair in Tropical Pediatrics
Co-Director, Texas Children’s Hospital Center for Vaccine Development
Texas Children’s Hospital
Founding Editor-in-Chief; PLOS Neglected Tropical Diseases

Biykem Bozkurt MD, PhD, FHFSA, FAHA, FACC, FESC, FACP
Mary and Gordan Cain Chair & Professor of Medicine
Director of Winters Center of Heart Failure
Associate Provost of Faculty Affairs; Senior Associate Dean of Faculty Devel
Vice-Chair, Department of Medicine
Baylor College of Medicine
Biykem Bozkurt, MD, PhD, FACC, Named New Editor-in-Chief of JACC: Heart Failure – American College of Cardiology

Overview:
Drs. Bozkurt & Hotez will discuss the impact of vaccinating on the delta variant accelerating in the US and advancing a low-cost recombinant protein COVID-19 “people’s vaccine” for global health expected to be released for emergency use in Asia. They will also discuss new trends in antivaccine sentiments in the US and an escalating and globalizing antiscience empire.

Objectives:
At the conclusion of the activity a participant should be able to:

1. Summarize the impact of the delta variant among unvaccinated populations in the United States and globally.
2. Report on global failures or weaknesses in vaccinating low- and middle-income countries especially in Latin America, Southeast Asia, and Africa, and our new “people’s vaccine” for global health now entering phase 3 trials.
3. Analyze the origins of rising antivaccine sentiments and its recent shifts.

Disclosures:
Dr. Biykem Bozkurt receives consulting fees from Amgen, Bristol Myers Squibb, scPharmaceuticals, Baxter Healthcare Corporation, Sanofi-Aventis, Relypsa and Vifor.
Dr. Peter Hotez has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation
Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Glenn I. Fishman, MD, FAHA
William Goldring Professor of Medicine, Department of Medicine
Professor, Department of Neuroscience and Physiology
Professor, Department of Biochemistry and Molecular Pharmacology
Vice Chair for Research, Department of Medicine
Director, Leon H. Charney Division of Cardiology
NYU Grossman School of Medicine
New York, NY

Overview:
Dr. Fishman will provide an overview of the normal function of the cardiac conduction system, its role in arrhythmogenic heart disease and the molecular mechanisms responsible for its development.

Objectives:
At the conclusion of the activity a participant should be able to:

1. Identify the components of the specialized cardiac conduction system.
2. Summarize diseases associated with conduction system dysfunction.

Disclosures:
Dr. Glenn Fishman has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation
Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Gabriel Loor, MD, FACC
Surgical Director, Lung Transplant Program
Co-Chief, Section of Adult Cardiac Surgery
Baylor St. Luke’s Medical Center
Associate Professor of Surgery, Cardiothoracic Transplant and Circulatory Support
Baylor College of Medicine
Houston, Texas

Overview:
Dr. Loor will discuss high risk scenarios in lung transplantation including concomitant cardiac surgical procedures, heart lung transplantation and preexisting cardiac disease. He will also discuss methods for mitigating risk and ensuring the safest outcomes possible.

Objectives:
At the conclusion of the activity a participant should be able to:

1. Describe the indications and outcomes for lung transplantation.
2. Discuss the implications of concomitant cardiac disease.
3. Explain the effects of circulatory support during lung transplant on the new allograft.

Disclosures:
Dr. Gabriel Loor receives grant support from TransMedics and Atricure.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation
Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Register for Livestream

Sean van Diepen, MD, MSc, FRCPC
Assistant Professor, Department of Critical Care Medicine
Division Of Cardiology
University of Alberta
Edmonton, Canada

Overview:
Dr. van Diepen will discuss the evolution of patient care, staffing and training from CCU to CICU.

Objectives:
At the conclusion of the activity a participant should be able to:

1. Highlight the changing CICU patient acuity and complexity.
2. Propose new staffing CICU models and review supporting evidence.
3. Illustrate maintaining competence and educational pathways for trainees.
4. Summarize evidence to support moving away from historical admission practices.

Disclosures:
Dr. Sean van Diepen has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation
Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Register for Livestream

Eric. V. Krieger, MD, FACC
Director, Seattle Adult Congenital Heart Service
Director, Adult Congenital Heart Disease Fellowship
Professor of Medicine, Division of Cardiology
University of Washington School of Medicine
Attending Physician; University of Washington Medical Center
Seattle, Washington

Overview:
Dr. Krieger will discuss pregnancy in women with valvular heart disease with attention on management of women with mechanical heart valves and anticoagulation strategies. He will also discuss the impact our style of counseling has on patient understanding of risk.

Objectives:
At the conclusion of the activity a participant should be able to:

1. Describe the impact of valvular heart disease on pregnancy outcomes.
2. Access the risks of different anticoagulation strategies for mechanical heart valves in pregnancy.
3. Illustrate how the language we use in patient counseling impacts patient understanding of risk and decision making.

Disclosures:
Dr. Eric Krieger has nothing to disclose relevant to this program.

The Planning Committee has nothing to disclose relevant to this program.
The THI CME Staff has nothing to disclose relevant to this program.
The Program Reviewers has nothing to disclose relevant to this program.

All relevant financial relationships have been mitigated.

Accreditation
Texas Heart Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
Texas Heart Institute designates this live activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.