CVM Grand Rounds Marc Pelletier

Name: CVM Grand Rounds Marc Pelletier
Uploaded: 2025-10-29T18:49:35.2233333Z
Duration: 1 h 8 min 52 s

October 29, 2025

Information

ID: 13569
To Cite: DCA Citation Guide

Download Transcript

01:45So we're using this keyboard
01:46Okay. Down here. This will
01:48be from speaker. This will
01:49be from your side. Okay.
01:50Great.
01:51Good to go. And intros
01:52are ready to go? Yep.
01:53The intros are ready to
01:54go. And then we'll switch
01:55it over on the back
01:56end so it has to
01:57do it. Okay. That's good.
04:32Okay, everyone. Let's go ahead
04:34and get started. Thanks for
04:35everyone to come coming out.
04:37We have a special treat
04:38today. Before we get started,
04:40just remind everyone that, we
04:41provide
04:43CME, credit, and please,
04:45text five four three three
04:47five
04:48for those of you,
04:50to get, this credit. We
04:52are monitoring this,
04:53and, really appreciate everyone coming
04:55out. And and, welcome to
04:57all the
04:58faculty and fellows and colleagues
05:01across our
05:03wide system,
05:05who are at our different
05:06watch parties. We have, I
05:07think, five different watch parties
05:08going on. So there's many
05:10people
05:11listening and,
05:12getting lunch and and experiencing
05:14this as well. So,
05:16let me just
05:17move this. Just, to remind
05:19people of the schedule next
05:21week,
05:23we have,
05:25Mark Petrie.
05:26Mark, is phenomenally,
05:29a wonderful colleague, close friend
05:30to many of us,
05:33and
05:34will be coming and visiting
05:35us from University of Glasgow.
05:38Really, it's,
05:39parlayed this focus on,
05:43on heart failure as well
05:44as interventional cardiology,
05:47and is playing an important
05:48role,
05:50in in many, different channels,
05:52globally. So he'll be visiting
05:53with us and excited to
05:54have him. For those of
05:55you who want to meet
05:56with him,
05:59please reach out to Joanne
06:00and Bianca who are gathering
06:02information as we finalize his
06:03his schedule.
06:04We have a follow-up EP
06:06case conference led by Gabriela.
06:08By the way, the fellows
06:09have been doing a fantastic
06:11job with our case conferences.
06:12They've been really exciting, and
06:13I love this new, new,
06:16process we put them together.
06:17Thanks to
06:18Catherine and and, Philippe and
06:20and Hattie.
06:21Todd Vilnius will come in
06:22the subsequent week, to be
06:24our,
06:26Zarett,
06:28Giants in Cardiovascular Medicine lecturer.
06:30That day will be also
06:32the day of the day
06:33long symposium,
06:36that, is being led in
06:38after Zarate's honor as well,
06:39and Al Senussis is organizing
06:41and finalizing that with Roberta.
06:43So if you have any
06:44questions about that, please reach
06:45out to him. And then
06:46we have a peripheral vascular
06:48case conference after that. These
06:49are our disclosures and accreditation,
06:51and I with that, I'm
06:52gonna ask Casper here to
06:53give a quick intro,
06:54to our,
06:56my my,
06:58great new colleague, and we're
06:59excited to have Mark here
07:00with us. It took us
07:01a while to get to
07:02this point, but,
07:03he had brought, really, tremendous,
07:08credit to us already, since
07:09his,
07:10what, six months since he's
07:11been here. So excited to
07:12have you here. And, Catherine's
07:14gonna introduce you more formally.
07:20Hey. Good afternoon, everybody.
07:22It's now my pleasure to
07:24formally,
07:25introduce doctor Pelletier.
07:27He's our division chief here
07:29of cardiac surgery,
07:30of the department of surgery
07:32here at the Yale School
07:33of Medicine.
07:34He's the section chief of
07:35cardiac surgery for Yale New
07:36Haven Hospital and the physician
07:38in chief of cardiac surgery
07:40for our YNHH Heart and
07:41Vascular Center.
07:43A graduate of McGill University,
07:45he completed advanced training in
07:47advanced heart failure surgeries, including
07:49bad and cardiac transplantation at
07:51Stanford University.
07:52His clinical interests also include
07:54TAVR, minimally invasive mitral valve,
07:57and coronary bypass surgery using
07:59arterial grafts as well as
08:01aortic and heart failure procedures.
08:04Prior to Yale, he served
08:05as a division division chief
08:07in cardiac surgery and held
08:08the JL Ankeny professorship in
08:11CT surgery
08:12at University Hospitals Cleveland Medical
08:14Center and Case Western Reserve
08:16University.
08:17He also served as director
08:19of the Heart Surgery Center
08:20at Harrington
08:22Heart and Vascular Institute.
08:24Prior to that, he was
08:25a surgical director of the
08:26TAVR program at the Brigham
08:27and Harvard Medical School.
08:29He joined the Brigham Group
08:31in two thousand sixteen
08:32after nine years as head
08:34of cardiac surgery at the
08:36New Brunswick Heart Center in
08:37Canada, which followed a period
08:39of assistant professor in cardiac
08:41surgery at Stanford.
08:43Doctor Pelletier has led PI
08:45for several industry funded clinical
08:47trials, has authored numerous peer
08:49reviewed publications and leading journals
08:51such as CERC and the
08:52New England Journal, as well
08:53as Too Many to Count
08:54invited talks. And in the
08:56past few years, his interests
08:57have shifted towards clinical outcomes
08:59research.
09:00In other leadership roles, he
09:02chaired the Royal College of
09:03Surgeons of Canada's cardiac surgery
09:05board exam and was named
09:07specialist of the year by
09:09the Royal College in twenty
09:10fourteen.
09:11He currently serves as program
09:13chair for the Society of
09:14Thoracic Surgeons twenty twenty six
09:16meeting and also serves on
09:18multiple STS workforces.
09:21In addition, he is a
09:22respected educator who was recognized
09:24with the prestigious
09:25Larry Cohen outstanding teacher award
09:27in twenty eighteen at the
09:29Brigham.
09:30And just this past year,
09:31he was awarded the Socrates
09:32award by the Thoracic Surgery
09:35Resonance Association,
09:36recognizing an outstanding CT surgery
09:39faculty member in North America
09:40for their commitment to education
09:42and mentorship.
09:43Now please join me in
09:44welcoming doctor Pelletier.
09:55Thank you very much, Catherine,
09:57for the really nice introduction.
09:59I'm honored to be here.
10:00It's always a pleasure to
10:01speak to my cardiology colleagues.
10:04You seem to be always
10:06nicer than my surgical colleagues,
10:07so hopefully that will
10:09hopefully that will hold through
10:11to true true today.
10:20These are my disclosures,
10:23and, these are some of
10:24the objectives that we will,
10:26try to cover,
10:27today.
10:28Specifically, this will be probably
10:30a bit of a different
10:30talk. We're not gonna be
10:31too scientific today. The goal
10:33is really to introduce you
10:34to some of the thoughts
10:35about cardiac surgery. There have
10:37been a lot of changes
10:38in cardiac surgery here over
10:39the last few years. As
10:41you know, doctor Gerson, who
10:42was a good friend of
10:43mine, had left for for
10:44Columbia.
10:45There was a transient leadership
10:47role for about two years.
10:48And so I arrived in
10:49March, and, we've been trying
10:52over the first few months
10:53just to get a sense
10:54of the landscape. But I'll
10:55share with you maybe some
10:56thoughts today on on what's
10:57important in cardiac surgery.
10:59And because there's nothing that
11:01we do that doesn't interplay
11:02with our cardiology colleagues, it's
11:04very much of a team
11:05approach even though we may
11:05be in different departments.
11:07It's really important that we
11:09are aligned together.
11:10I thought I would take
11:11a few minutes because when
11:12I was asking people what
11:13I should talk about,
11:15almost everybody said, well, how
11:16did why did you come
11:17to Yale, and how did
11:18this all happen? And Catherine
11:20covered a little bit of
11:20that. But I I thought
11:22I would just maybe expand
11:23a little bit on that
11:24because I actually grew up
11:25not that far away. I
11:26grew up just on the
11:27Canadian border.
11:28If you go up the
11:29I ninety five and you
11:30drive for about eight hours,
11:31you'll get to where I
11:32I grew up from.
11:34And I actually grew up
11:35right on the American border.
11:36In fact, this is where
11:38this is the Saint John
11:39River, which separates the United
11:41States from Canada. And in
11:42the wintertime, when I was
11:43a kid, we could walk
11:44across the US, and,
11:46now I probably get shot
11:47or something. But
11:49back
11:50back then, it was it
11:51it was pretty easy, to
11:52do. In fact, my father
11:54would cross the bridge every
11:55day.
11:56I went to medical school
11:57in Halifax, Nova Scotia, which
11:59was a wonderful place to
12:00be. It's kinda like a
12:01mini Boston if ever any
12:02of you have ever gone
12:03to Halifax. It's surrounded by
12:04water, and it's a really
12:05nice university town.
12:07I met my wife, Missy,
12:09and we'll be married for
12:10thirty years in December if
12:11we make it that far.
12:12So, it's she's been an
12:14unbelievable partner.
12:16I was able to go
12:16into McGill in Montreal, which
12:18is a just a wonderful
12:19city to live in,
12:21and a great educational experience.
12:23At that time, we started
12:25our family in residency for
12:27so for those of you
12:27who are residents and trying
12:29to maneuver a family,
12:30I know what that's like,
12:32before the eighty hour work
12:33week. So I I feel
12:35your pain.
12:36We have four boys, and
12:37they've all grown up and
12:38are all in college now.
12:40And, they they really are,
12:41a blessing to us.
12:43But at McGill, as many
12:45of you probably have encountered
12:46here or in other areas,
12:48probably the biggest impact and
12:49the people that make the
12:50biggest difference on us are
12:52the mentors that we get
12:53to meet, the people that
12:54we get to meet. The
12:56gentleman in the middle is
12:57Denton Cooley when he was
12:58a visiting professor, but the
12:59man to his left is
13:00Ray Chu, who was my
13:02thesis adviser, was the chief
13:04of cardiac surgery there for
13:05a while,
13:06originally from Taiwan and immigrated
13:08to Canada and was just
13:09the the most wonderful human
13:11being that I I learned
13:12so much from.
13:13And similarly, this, gentleman, David
13:15Mulder,
13:16who's head of the American
13:17Trauma Association, also a cardiac
13:19surgeon, and was a chair
13:21of surgery there for many,
13:22many years. And more importantly
13:24to me, was the team
13:25doctor for the Montreal Canadians.
13:27So I had a side
13:27time job where I could
13:29go to the games for
13:30free and, look after the
13:31players,
13:32but mostly the drunken fans,
13:33especially the ones that came
13:35up from Boston, actually, for
13:36the Bruins and Canadians games.
13:39And then, you know, as
13:40a lot of things happen,
13:41sometimes just luck falls on
13:43your side. I was operating
13:44one day in December. I
13:46was finishing in June in
13:47June. I wasn't sure what
13:49I was doing. And, the
13:50guy operating with me said,
13:51hey. Do you wanna go
13:52to Stanford for a fellowship?
13:53They just called me today.
13:55They have a spot open.
13:56And I was like, yeah.
13:57I'd love to go to
13:58Stanford. That sounds great.
13:59And at Stanford, I I
14:01really got a chance to
14:02spend not just a year
14:03as a fellow, but four
14:04years as an attending.
14:06In that process, I had
14:07a chance to
14:09get to know Norm Shumway,
14:10who, those of you may
14:12know doctor Shumway,
14:13did the first American
14:15transplant heart transplant.
14:17In fact, Christian Barnard did
14:19the first one. And at
14:20Stanford, we would always say
14:21that was the biggest intellectual
14:23theft in, medical history because
14:25Christian Barnard, and you may
14:27know the the the story,
14:28Tarek,
14:29went to Stanford. Some way
14:31would always put his arm
14:32around you and say, hey.
14:33Let me show you what
14:33we're doing. We've done three
14:34hundred dogs and this and
14:36all that. But, you know,
14:37we're not quite ready to
14:38do it because the laws
14:39won't allow me to. I'll
14:40probably go to jail if
14:41I take a brain dead
14:41donor in California.
14:43And so Christian Barnard promptly
14:44went back to South Africa
14:46and did the first transplant
14:47in the world, all based
14:49on the work that Norm
14:50Shumway and Richard Lauer had
14:52done.
14:53But I got to know
14:54doctor Shumway. I got to
14:55play golf with doctor Shumway
14:57quite a bit, and that
14:58was really a a unique
14:59experience.
15:00And here is doctor Shumway
15:01sitting at rounds. Even though
15:03he was retired, he would
15:04come into work every day.
15:05He would attend our selection
15:06committee meeting, and it was
15:08just a wonderful human being.
15:10The other individual I met
15:11there was who made a
15:12profound impact on my life
15:13was Bruce Wright, who did
15:15the first heart and lung
15:16transplant in the world, was
15:17chair at Johns Hopkins and
15:19then came back to Stanford
15:20to be chair. And, Bruce
15:21is the one who hired
15:22me to stay at Stanford,
15:23and I'm forever grateful to
15:24him. And as much as
15:26we loved Stanford,
15:28we we missed home, and,
15:29we missed the way of
15:30life in Canada. And this
15:32was very important, especially as
15:33I our fourth son was
15:34born.
15:35And I I was working
15:37really hard, which is fine.
15:38We all do when we're
15:38young, but it probably was
15:40a little bit too much
15:41on the work side. And,
15:42we decided to move back
15:43to Canada, which I think
15:44allowed me to be a
15:45better father. So we packed
15:47up, the four kids in
15:48a Toyota Sienna
15:50with a roof rack on
15:51the top and a dog,
15:53and it all went well
15:54for the first few hours
15:55until two of my children,
15:57threw up on the dog
15:58as we were pulling into
16:00Reno, Nevada. So we spent
16:01the the evening in the
16:02bathtub washing the dog and
16:04the car and the, the
16:05kids. But we over eight
16:06days, we made it back
16:07to Canada, and this was
16:09probably, a ten years of,
16:10a great experience for me.
16:12I I was young at
16:13the time, but I was
16:13a chief of that program.
16:15It was a provincial program
16:16where we interacted with the
16:17minister of health on a
16:18regular basis. The Canadian program's
16:20a little bit different, but
16:22we were able to grow
16:22a program that was doing
16:23around five, six hundred a
16:24case cases a year to
16:26about eight, nine hundred cases
16:27a year and and really
16:28gave me a a wonderful
16:29ex opportunity in leadership.
16:31It was the first time
16:32that I did, coaching to
16:33try to be a better
16:34leader, and I've I've gone
16:36on to do that now
16:37four other times.
16:38But, after a while in
16:40the Canadian system, there is
16:41a ceiling,
16:42and I I felt that
16:43for me, I we had
16:44accomplished there everything that we
16:45could.
16:47Maybe one straw that broke
16:48my back a little bit
16:49there. We'd worked for three
16:50years to build a brand
16:51new building, a heart and
16:52vascular center.
16:53We had all the funding.
16:54Everything was in place, and
16:56then there was an election.
16:57And then the party in
16:58power shifted to another party
17:00in power, and all of
17:00a sudden, everything was scrapped.
17:02And three, four years of
17:03work kind of was just
17:04put on complete hold. So
17:05at that time, I thought
17:06it was maybe good to
17:07reintegrate back into the American
17:08system.
17:09My older son was gonna
17:10go off to to college,
17:11so it was a good
17:12time. I was offered a
17:13position at, at the Brigham.
17:16And Brigham, really wonderful storied
17:18institution.
17:19One of my favorite meetings
17:20at the at the Brigham
17:21was a luncheon like this.
17:22I was grabbing a a
17:24box, and, this little guy
17:25was next to me, and
17:26he was like, hey. How
17:27are you doing? Jean. Jean
17:28Jean Brunnold.
17:30I was like, hey, doctor
17:31Brunwald. Mark Kelsey. Nice to
17:33meet you.
17:34But just,
17:35and if any of you
17:36have been at the Brigham,
17:37of all the places I've
17:38visited and have worked, the
17:40Shapiro building there is an
17:41absolute beautiful facility for patient
17:43care. If any of you
17:44had the chance to visit,
17:46all the patient rooms are
17:47individual patient rooms. They all
17:48have a couch that folds
17:49into a bed. Even the
17:51ICU beds, the the families
17:52are encouraged to stay there
17:53at night in the ICU.
17:54They're encouraged to stay there
17:56during the day. It's very
17:57family focused. In that entire
17:59building
18:00are all the offices where
18:02surgeons and cardiologists interact together.
18:04Like, how nice is that
18:05where, you know, I I
18:06shouldn't be in an office
18:07with plastic surgeons and colorectal
18:09surgeons. I should be in
18:10an office in the same
18:11area with you, with cardiologists,
18:13but that's the way we
18:14have it divided here currently.
18:16But that's one of the
18:16things I I would love
18:17to see change a little
18:18bit. The conference rooms are
18:20in this building. The ORs,
18:21the cath labs are all
18:22just down below. So it's
18:23all just one entity within
18:25kind of a hospital system
18:26like this, which is a
18:27little bit, hodgepodge as it's
18:29been built over the years.
18:31Anyway, I had a good
18:32tenure there, and I was
18:33offered a a chance to
18:34join Joe Sabik at Case
18:36Western,
18:37which I thought for me
18:38was very important. It was
18:39a leadership position in the
18:40states. So once more, I
18:42told the boys we were
18:43packing up. We went to,
18:44Cleveland,
18:45and really had six wonderful
18:47years there with an amazing
18:48group,
18:50you know, that had been
18:50led by Dan Simon who
18:52was formerly at the Brigham
18:53and and who had really
18:54revamped that group. And on
18:55the surgery side,
18:57this is Joe Sabik, who's
18:59department chair. He's the STS
19:00president this year.
19:02Joe has asked me to
19:03be the program chair meeting
19:05for the twenty twenty six
19:06STS, and it's wonderful to
19:07be able to do to
19:08do that. And, this guy
19:10we recruited from Papworth Yasser
19:12Abu Omar,
19:13and he's now currently the
19:14chief. So it was nice
19:15to be able to be
19:15the chief, recruit somebody, and
19:17have an internal candidate that
19:19came up and, and took
19:20that position.
19:21And we had a very
19:22collegial team there. Here we
19:24are skiing, at Vail. A
19:25whole bunch of us would
19:26go, every year, but I
19:28was introduced to the,
19:30the absolute
19:32despair that is to be
19:33a Cleveland fan.
19:35Boy, oh, boy, I'm I'm,
19:36you know, I kinda like
19:37the Browns, but I'm glad
19:38I didn't grow up rooting
19:39for the Browns because it
19:40it's just, one season of
19:42despair after another.
19:43And doctor Kelsey Gray was
19:45our trainee there. I'll introduce
19:46you to her later. She'll
19:47show a couple of videos
19:48of some of the really
19:50cool and amazing stuff, that
19:51she's doing.
19:52And this was the setup
19:53of our program in Cleveland
19:55where we actually,
19:56ran a central hub and
19:58spoke system with a central
19:59hospital that was our quaternary
20:00cardiac surgery center and five
20:03other hospitals around it that
20:04all did behind between a
20:05hundred and two hundred cases,
20:07but would feed all of
20:08our complex cases into our
20:09quaternary center. These were all
20:11the same surgeons, same perfusionists,
20:13same OR assistance that would
20:15travel from from site to
20:16site.
20:18And so, I was approached
20:20a little while ago about
20:22the position at Yale, and
20:23it just seemed that the
20:24timing was right. Our youngest
20:25boy was leaving the house.
20:26We weren't gonna be moving
20:27any kids at all anymore,
20:29which we had promised not
20:30to do. And I miss
20:31being on the East Coast
20:32where my wife and I
20:33are both from New Brunswick.
20:34We like being close to
20:36family,
20:37and also the opportunity to
20:38work at Yale, and maybe
20:40some of us take that
20:41for granted. I know some
20:42of you take that for
20:43granted because I hear it
20:44all the time. You work
20:45in an amazing institution
20:46with an international reputation that
20:48you probably don't even realize
20:50how good it is, and
20:51we sometimes focus on the
20:52internal negative things that we
20:54have. But we we are
20:55all fortunate to work at
20:56an unbelievable
20:57institution.
20:58I'm also fortunate to work
20:59with a lot of really
21:00good partners, and I think
21:01you've all interacted with some
21:03of these individuals.
21:04But John Eleftheriades,
21:06who was really,
21:08helped to pave the way
21:09for how well known Yale
21:10is in the cardiac surgery
21:12community
21:12because of his aortic work.
21:14Prashant, as you know, has
21:15done just an amazing job
21:17with, a multitude of tough
21:19aortic cases,
21:20and I'm surrounded by a
21:22host of really smart, talented
21:23people, Rita Malewski, Pramod Bond,
21:26Matthew Williams.
21:28Our our congenital team with
21:29Peter, Gruber and Madonna Lee.
21:32Our our VA team and
21:33Roland Ossie is on here
21:34because he's leading that team,
21:35but Roland is really more
21:36here than he is there.
21:37And an amazing young surgeon
21:39who's NIH funded along with
21:41George Salides and our Bridgeport
21:43team that's responsible for a
21:45lot of our, volume.
21:46Later on, you'll get to
21:47meet doctor Kelsey Grace. So
21:49one of the things that
21:50you do when you come
21:51in is you try to
21:51assess the needs of an
21:52institution
21:53and you try to hire
21:54people that will fill in
21:56some of those needs.
21:57Our transplant program had
21:59a need for somebody who
22:00was technically very strong, and
22:02Kelsey is somebody that we
22:03had trained in Cleveland, did
22:05all of our heart and
22:06lung transplants, VADs,
22:08amazingly,
22:09good technical surgeon and a
22:10wonderful human being, and she
22:12agreed to to jump ship
22:13and to join us here.
22:14So thank you, Kelsey.
22:16And, Makoto Mori also this
22:18was really important to hire
22:19somebody like Makoto. He was
22:21one of our trainees. It
22:22sent a very strong message.
22:23This was somebody that was
22:24part of our our, research
22:26program as a resident, was
22:28an amazingly
22:29prolific author, and went to
22:31do a fellowship. And to
22:32bring somebody like that is
22:34not only good
22:36for us, but I think
22:36it sends a a wonderful
22:36message to the people that
22:37we have at Yale that
22:38if you do well here
22:39and you you do good
22:41things, we wanna keep you.
22:42We wanna bring you back
22:43here. I'm particularly fond of
22:44this photo. Now I shouldn't
22:46be. It's it's difficult to
22:47say that in twenty twenty
22:48five, you're so proud of
22:50an all female team. But
22:51you have to understand where
22:52we came from in cardiac
22:53surgery. Ten or fifteen years
22:55ago, ten percent or less
22:56of our workforce was female.
22:58We are making great strides,
22:59but we are still behind
23:00a lot of the other
23:01specialties.
23:02So this was a case,
23:03I think, last week or
23:04so.
23:04Kelsey was operating, and we
23:06had, you know, our tech,
23:07our perfusionist, our anesthesiologist.
23:09The entire team was was
23:11female, and it was just
23:12awesome to see, and they
23:13were so proud, to to
23:14take this photo. The only
23:15one who's not smiling and
23:16focused there is doctor Gray.
23:18I think she's doing a
23:19distal or something like that.
23:20She
23:21and as you know in
23:22the operating room, which is
23:23a little bit different sometimes
23:25than in the cath lab,
23:26and I've spent a lot
23:27of time in the cath
23:27lab where you have two
23:29or three, four people, and
23:30that's usually plenty to do
23:32what you need to to
23:32do. We need a lot
23:34of help in cardiac surgery.
23:35There's nothing that I do
23:36that I can't do by
23:37myself,
23:38and that team involves a
23:39whole bunch of people. And
23:41that's where I think Yale
23:42my observation has been is
23:43particularly strong. We are I
23:45I describe to people all
23:46the time. I think we
23:47are people strong. Sometimes we're
23:49a little bit resource poor
23:50or we act like resource
23:51poor, but we're people strong,
23:53whether that's nursing, anesthesia,
23:55our physician assistant teams, our
23:57perfusion team,
23:59and that goes on to
23:59our ICU team and our
24:01nursing team. And and I
24:02think a a bunch of
24:03absolute rock stars, which is
24:04our residency program.
24:06These these guys and girls
24:08are amazing. They're doing incredible
24:10things, and it's really an
24:11honor to try to help
24:12them along, in their career.
24:15So to share with you
24:16a little bit of where
24:17we are now, so we
24:18are known for a lot
24:19of things, mainly our aortic
24:20program that's that was led
24:22by John e, Our structural
24:24heart program that has been
24:25led by John Forrest and
24:26Amit and every the whole
24:28the entire team has nationally
24:30been involved in in big
24:31trials.
24:32When R and R was
24:32here, there was a big
24:33robotic mitral presence. We were
24:35doing fifty to eighty robotic
24:36mitrals a year and bringing
24:38groups in. But when R
24:40and R left in twenty
24:41three, that skill set disappeared
24:42here for a couple of
24:43years, and we've been able
24:44to bring it back. And
24:45doctor Glenn for the Glenn
24:47procedure and our Glenn chair,
24:49really put Yale on the
24:50map many, many years ago.
24:52This is our volume over
24:53the last few years, and
24:54as you can see, it's
24:55been relatively steady. We've had
24:57minor ups and downs, but
24:58never more than about a
25:00five or ten percent variation.
25:02And then when you look
25:03at where that volume is
25:04coming from, about four fifths
25:05of it, about eighty percent
25:07of it is done here
25:08at Yale, and the rest
25:09is done at Bridgeport.
25:11And when we break that
25:12down a little bit more
25:13in term terms of the
25:14major procedures that we do,
25:16you'll see that by far
25:17the the biggest number of
25:18isolated procedures we do is
25:20coronary bypass surgery. That's still
25:22the biggest, thing that we
25:23do, but that's changed a
25:24lot. When I trained, I
25:25finished training in two thousand.
25:27That was about eighty percent
25:28of our cases were coronary
25:30bypass surgery. But all the
25:31advances in stenting, which are
25:33are wonderful advances,
25:35all our advances in other
25:36procedures,
25:37TAVR, things of that nature,
25:38MitraClip,
25:39has made so that our
25:41our landscape is a little
25:42bit different now. We do
25:43a lot more complex cases,
25:45a lot more combo cases,
25:47and and this kinda reflects
25:48how that volume is distributed
25:49in terms of the Kabbage
25:51distribution
25:52a little bit between Bridgeport,
25:54and Yale.
25:55Now
25:56these are some of the
25:57things that when you're in
25:58training or maybe you're in
25:59the middle of it, you
25:59don't think about. But these
26:00are the things that I
26:01think about, which is how
26:03can we grow our program?
26:04Where's our volume coming from?
26:06And this is an idea
26:07of the distribution of where
26:08that volume comes from in
26:09the state of Connecticut.
26:11You'll see that everything in
26:12blue or dark blue is
26:13where we have significant market
26:14share, forty, fifty percent and
26:16above.
26:17And you'll see everything in
26:17gray is where we have
26:18very little market share. We
26:19have ten percent or below
26:21of that market share. So
26:22as you can see there,
26:23it's like looking at an
26:25electrical map in, California. You
26:27know, it's all red except
26:28for little blue spots, but
26:29it's a little bit like
26:30that where we've got a
26:31lot of blue on the
26:31on the coast, but we've
26:33got a lot of opportunity.
26:34And the reason I show
26:35you that is I think
26:36that we have opportunities for
26:38growth as we expand our
26:39services.
26:39We have opportunities in New
26:41York, we have opportunities in
26:42Massachusetts, but we do need
26:44to get our backyard,
26:45in order.
26:47This is the our market
26:48share currently as a heart
26:49and vascular system. You'll see
26:51in red as Hartford, and
26:52here we are in in
26:53blue. We're a little bit
26:54behind in terms of totality,
26:56but this is where we
26:57are in cardiac surgery. We
26:58have a lot of work
26:59to do. We have lost
27:00market share over the last
27:01five, six years, and we
27:03are trailing Hartford not just
27:04by one or two percentage
27:05points, but we're trailing them
27:07by a significant proportion in
27:08our market share. So that's
27:10part of the reason that
27:11I've I've been tasked to
27:13try to lead the division,
27:15try to improve our our
27:16volume, and improve, well, what
27:18we're doing. We'll dive more
27:20into that a little bit
27:21in a few minutes, but
27:21I want to touch base
27:22a little bit on our
27:23clinical trials. We have a
27:25a very robust research program
27:26that is not just in
27:27clinical trials. We have basic
27:29scientists that are NIH funded.
27:31We have two CS track
27:32faculty,
27:33in our division, in a
27:34division of twelve, which is
27:36a lot.
27:37And we have pretty robust
27:38clinical outcomes, program. So we've
27:40been very proud of this,
27:41and this has led to
27:42a a lot of initiatives
27:44and a lot of papers.
27:45Now I wanna touch base
27:46on our quality, and then
27:47we're gonna be this is
27:48a little bit advanced. We're
27:49gonna be presenting this at
27:50our division meeting on on
27:52Friday morning. But just to
27:54show you a little bit
27:54of an idea of where
27:55we are. And I'm showing
27:56you this because the results
27:58are good, but they're not
27:58perfect. And I'm showing you
28:00that because
28:01probably like everybody, every division,
28:03we have room for growth
28:04and room for opportunity.
28:06But unless you know your
28:07data and unless you're reviewing
28:09your data, you don't know
28:10what those opportunities
28:11might be. So this is
28:13a busy slide, but it
28:13speaks really to cardiac surgery.
28:15And we have these scorecards
28:16not just for us in
28:17cardiac. They exist for cardiology
28:19as well, door to balloon
28:20times, for example,
28:21readmissions for heart failure. But
28:23I'm focusing here a little
28:24bit on cardiac surgery.
28:26And you see that we
28:27have anything that's yellow or
28:28red is is really
28:30not in the top fifty
28:32percentile, some some sometimes not
28:34in the top seventy fifth
28:35percentile.
28:36So our readmission rates, the
28:37fifty percentile is around eight
28:39percent. We're around eleven percent,
28:40so we have room to
28:41go there. Our utilization of
28:43pathways needs to improve.
28:45Our days in acute care
28:46seem to be high, compared
28:48to the average. Now having
28:49said that, our results are
28:51quite reasonable. Our observed to
28:52expect in mortality is around
28:54zero point seven five, which
28:55means that for several years,
28:56we've had a better results
28:58in terms of our mortality
28:59than what would be expected.
29:03If we look at other,
29:04things,
29:05again, inpatient mortality has been
29:07relatively low. Where we are
29:08in US News rankings in
29:10terms of mortality for TAVR,
29:11extremely, extremely good, and we're
29:13happy to be, part of
29:15that program with triple a's.
29:16We're pretty good. But, again,
29:18we have we have a
29:18lot of room here for
29:19improvement. And when we dive
29:21into those, a couple really
29:22good things is that for
29:24the first time now ever,
29:26the STS is our national
29:27body, our national database. It
29:29has millions and millions of
29:30patient records, and we are
29:31in there as an institution.
29:33For the first time, we
29:34are now three stars in
29:36at least three categories,
29:38in the AVR and CABG
29:39combined category,
29:41in the mitral valve and
29:43mitral valve replacement and repair
29:45category,
29:45and also here in the
29:47multidisciplinary
29:48or multi,
29:49procedural category. So that would
29:51be somebody with an ascending
29:52aorta and an aortic valve
29:54or an ascending aorta in
29:55a CABG. So we are
29:56obtaining good results, but we
29:58have room to improve.
30:00And the way that we
30:00measure these are really in
30:02two different ways. There are
30:04things that are called process
30:05metrics,
30:06how well we're doing things,
30:07and there are outcome metrics.
30:09Outcome metrics, you can't always,
30:12prevent somebody from having a
30:13stroke. You can do all
30:14the things that you can
30:15or somebody
30:16prevent somebody from dying. Those
30:18are your outcomes. But the
30:19process metrics are things that
30:21we can control. And I've
30:22always felt strongly that if
30:23our processes
30:24are good, then our outcomes
30:26should be good. And even
30:28in our processes, as you'll
30:29see, we have room for
30:30improvement.
30:31So when we look at
30:32CABG, CABG is how you
30:33grade a lot of cardiac
30:35surgery programs because as you
30:36saw from the previous slide,
30:38it's the biggest proportion of
30:40what we do. We are
30:41a two star program in
30:42coronary bypass surgery. About eighty
30:44percent of the programs in
30:45the United States are two
30:47star programs. The top ten
30:48percent are three star, and
30:50the top, the bottom ten
30:52percent are are one star.
30:54In Cleveland, we led an
30:55effort. It took us three
30:57to four years to get
30:57to that point, but we
30:59got to the point that
30:59we were a three star
31:00program. And we got to
31:01that point by paying attention
31:03to our process metrics, which
31:05then in turn improved our
31:07outcome metrics.
31:08So in terms of our
31:09composite quality ratings, you'll see
31:11that the dotted line is
31:12the STS average, and the
31:14black line is where we
31:15are. So we are better
31:17than average in terms of
31:18our outcome metrics,
31:20but we're not yet in
31:21that top ten percent.
31:24In terms of isolated metrics
31:25here, what you're seeing is
31:27that in terms of our
31:28mortality, we had peaked at
31:29around three percent. We went
31:31as low in twenty three
31:32as around one percent, and
31:33we've crept up in that
31:34one point five percent range.
31:36But, again, compared to our
31:38standardized,
31:39colleagues across the country, we
31:41are doing well. But, again,
31:42we have some room for
31:43improvement.
31:44And when this is a
31:45small slide, but when you
31:46look at some of these
31:47numbers, you'll see we don't
31:48have to change a lot
31:49of these to make a
31:50big difference if we get
31:51two less sternal external wound
31:53infections, if we have a
31:54few less readmissions, those are
31:55all things that can can
31:57really help us tremendously.
31:59And then we look at
31:59these composite morbidity trends again.
32:01They they tell us they
32:02inform us of where we
32:04are. So we're in the
32:05process of working with our
32:06quality team, and these are
32:07things that we wanna present
32:08on a regular basis. If
32:09you look at outcome metrics
32:10that are perhaps important but
32:12less so than than stroke
32:13or mortality,
32:14you'll see that our external
32:16wound infections over a running
32:17three year period are higher
32:18than they should be. So
32:20we'll we'll be starting to
32:21look at that. You look
32:22at some of the other
32:23areas here. Reexploration
32:25for bleeding is a little
32:26bit higher than it should
32:27be. Stroke and CVAs are
32:28a little bit higher than
32:29they should be.
32:30So those are areas that
32:32we can improve if, I
32:34think, we improve these process
32:36metrics. So these are where
32:37these process metrics stand. And
32:39as you'll see in all
32:40of them, this is our
32:42score. This is the average
32:43SCS score and the fiftieth
32:45percentile
32:46of like minded,
32:48programs. And on all of
32:49these, we're kind of in
32:50that fiftieth to seventieth percentile,
32:52so some room for improvement.
32:54If you look at it
32:54a little bit differently here,
32:56so are we, for example,
32:58giving patients a beta blocker
32:59before surgery? Are we using
33:01internal mammary artery? And if
33:02we're not, are we documenting
33:04why we didn't use it?
33:05Are we discharging them on
33:06time? And we are we
33:07discharging them with the right
33:09medications? These
33:11are gimmes. Right? These are
33:12gimmes. These should be a
33:13hundred percent. And in fact,
33:15for you to be in
33:16the top ten percent, they
33:17need to be a hundred
33:18percent, not just for one
33:19year, but for three years
33:20consecutively,
33:21and then you'll be in
33:22the top ten percent of
33:24these programs. So even though
33:25our internal memory use is
33:26at ninety nine point four
33:27percent, it's not good enough.
33:29Right? So we have opportunities
33:30for improvement, and those are
33:32what some of our processes
33:33are. We have opportunities to
33:35work with our teams, residents,
33:37APPs on
33:38medication sets, preorder sets, because
33:40there are some of those
33:41medications that if you include
33:43the right phrases or when
33:44you're discharging these patients, it'll
33:46stop you and ensure that
33:47you're getting them after CABG
33:48on a beta blocker, a
33:50statin, and aspirin. Now the
33:51beta blocker data maybe is
33:53changing, but right now, that's
33:54still a a very important
33:56metric for us. So if
33:57we use these types of
33:58stop gaps, we have opportunities
33:59to capture those. And same
34:01in our discharge notes, we
34:02have an opportunity to or
34:04sorry, in our preop notes
34:05to make sure that they're
34:06getting the right soap, they're
34:07getting their preop with beta
34:08blocker. We're getting an incentive
34:10spirometer so we can really
34:11identify if they have lung
34:13dysfunction,
34:14or not.
34:15And on the US news
34:16and world ranking,
34:18we are doing okay. So
34:19there are around nine hundred
34:21cardiac centers that are ranked
34:22every year.
34:23Yale was not ranked for
34:24several years, debuted in twenty
34:26twenty four at forty three.
34:28And this past year, we
34:29are fortieth in the country.
34:31Keep in mind, that says
34:32a heart and vascular center
34:34among around nine hundred programs,
34:36in the country. So we're
34:37doing well. But I think
34:39all of you are at
34:40Yale because you're smart. You
34:41wanna be the best. We
34:42all wanna be the best.
34:43I think we have an
34:44opportunity
34:45to creep up that list,
34:46but it's all kinds of
34:47little things that we'll need
34:49to do. So that leads
34:50me to the next topic,
34:52which are some opportunities
34:53that I've observed. And so
34:55I had the chance while
34:56interviewing here to meet with
34:58a lot of people, and
34:59I had I've now been
35:00here for six months. And
35:02advice that I got early
35:03on was
35:04keep your mouth shut, keep
35:06your head down, work hard,
35:07try to listen as much
35:08as you can, try not
35:09to make too many major
35:10changes. There are some changes
35:12that you have to make,
35:13but I I've really tried
35:14to learn of what my
35:15new organization is, the teams
35:17that I work with, and
35:19the teams that are so
35:20important
35:21to the success, to mutual
35:22success. I think cardiology
35:24relies on cardiac surgery for
35:26some success, and we really
35:27rely on cardiology for the
35:28success that we have.
35:30So a few thoughts have
35:31come to mind, and I'd
35:32like to share those with
35:33you and go into a
35:34bit more detail with you
35:35because I think some of
35:36these pave the framework
35:38for what you will hopefully
35:39see out of our division
35:41in supporting you as better
35:42colleagues over the next few
35:43years.
35:44So what does that mean
35:46exactly
35:47to do a better job?
35:48Well, every year, I try
35:49to read a few books,
35:50and every year, one of
35:51them makes an impact on
35:52me. And one book that
35:54I read this summer really
35:55made a big impact on
35:56me. It's a book by
35:57Will Gudera called Unreasonable Hospitality,
36:00The Remarkable
36:01Power of Giving People More
36:02Than They Expect.
36:04And Will was the manager
36:05of Madison Park, eleven Madison
36:07Park in New York City.
36:09It's a tremendous book, and
36:10it's a story of how
36:11they took this restaurant from
36:12a restaurant that was just
36:13a decent New York restaurant
36:15to the number one restaurant
36:17in the world to a
36:18three star Michelin restaurant.
36:19And now since then, I
36:20think it's faded a little
36:22bit. But under Will as
36:23the manager, it was very
36:24good. And the quality that
36:26I made in this book
36:26was that
36:28Yale, like eleven Madison Park,
36:29is an amazing place. Right?
36:31The food is good. The
36:32care that we provide is
36:33really, really good. But how
36:35we deliver that care, how
36:36we make people feel, how
36:37easily we make that care
36:39accessible
36:40are all the areas that
36:42I I know you know
36:43this because we all talk
36:44about it. Is it easy
36:45to come to clinic? Is
36:46it easy to come into
36:47Yale? Is it easy to
36:48park? Right? Those are all
36:49the things that we kind
36:50of talk about, and it
36:52really resonated with me.
36:54And I want you to
36:54think a little bit about
36:55it differently. So, again, this
36:57is the world that I
36:58live in that these are
37:00numbers that you may not
37:01think about every day, but
37:02these are the DRGs, the
37:03average DRGs. So that's the
37:05payment
37:06that a hospital system gets
37:07in the United States when
37:08a patient is discharged
37:10with a certain diagnosis.
37:11And these are the types
37:12of values that you get.
37:13Now this would base change
37:15based on if you're in
37:16a rural area or in
37:17a big city like New
37:18York, if if you're a
37:19teaching hospital or not. But
37:21a PCI will bring in
37:22around eleven to thirty thousand
37:23into the institution. A Kabbage
37:25will bring around forty one
37:26to sixty thousand to the
37:27institution.
37:29An AVR or an MVR
37:30will bring in around this
37:31amount of money. And when
37:32you get to LVAD and
37:33transplants,
37:34those as a base are
37:35bringing in a hundred and
37:36ninety thousand dollars into the
37:37hospital. Now hospitals make or
37:39lose money if they take
37:41in a transplant patient and
37:42all the care costs are
37:43a hundred fifty thousand dollars,
37:45the hospital makes money. If
37:47that patient stays in for
37:48three months in the ICU
37:49with a trach and renal
37:51failure, we probably lose money.
37:52But that's the business side
37:54of what we do, and
37:55all of us
37:56have a role in in
37:57in that even though we
37:58may not see it every
38:00day.
38:00So I wanna then make
38:02you think a little bit
38:03differently about that. Let's say
38:04that you and your family
38:06wanna go on a cruise,
38:06and you call Carnival or
38:08whatever, and you say, I
38:09wanna spend seventy thousand dollars.
38:11I wanna bring that to
38:12your institution.
38:14What do you think that
38:14they're gonna do? They're gonna
38:15roll out the carpet for
38:16you. They're gonna make it
38:18really easy for you to
38:19get they probably will pay
38:20for your hotel or your
38:21transportation. It'll give you a
38:22nice suite. Right? And they'll
38:24certainly welcome you back if
38:25you need a redo or
38:26something of that nature.
38:28But how do we treat
38:29our patients? Now this is
38:30not this is not a
38:31knock against us. This is
38:32all of us do it
38:33this way. Right? Every institution
38:35does it this way. Right?
38:36We make them pay a
38:37lot of money for parking.
38:38I got in late this
38:39morning. I parked all the
38:40way on the roof. It
38:41took fifteen minutes by the
38:42time I found a spot
38:43and it came back down.
38:45We would call for an
38:46appointment sometimes. We get I'll
38:47give you an urgent appointment.
38:48It'll be about five weeks
38:49from now.
38:50We sometimes make patients wait,
38:52especially surgeons. We're notoriously bad
38:54for that when we get
38:55called into the operating room
38:56and our patients are waiting.
38:58We limit visiting hours. We
39:00give them world class food.
39:03So, you you know, but
39:04these are people.
39:06And in cardiac surgery specifically,
39:08whether we like it or
39:09not, they are bringing a
39:10huge source of income into
39:12our hospital system.
39:14If we lose even one
39:15of those patients or two
39:16or ten,
39:17ten patients is five hundred
39:18to seven hundred thousand dollars
39:20that did not come into
39:21our hospital system because we
39:23didn't bring that patient in
39:24or lost that patient. So
39:26how do we provide that
39:27exceptional care? How do we
39:28give them something that we
39:30think that is really good?
39:31Well, I think there are
39:32nonnegotiables.
39:33There are things that we
39:34already do, and I I
39:35think we can never get
39:36away from this. Providing guideline
39:38and evidence based care, appropriateness
39:40of treatment, collegiality and teamwork,
39:43all those things, kindness,
39:44strong and and meticulous surgical
39:46care. You know, for us
39:48as surgeons, we have to
39:49be good surgeons.
39:52But we probably have some
39:54way to provide better access.
39:55So one of the things
39:56over the six months, I've
39:58had dinners and meetings with
39:59cardiologists in Rhode Island, in
40:01Lawrence Memorial area, down in,
40:04the Greenwich area. And one
40:05of the things we heard
40:06over and over is that
40:07a lot of those patients
40:08find it hard to get
40:09to New Haven. They find
40:11it hard to get all
40:11the way to us. They
40:12find it hard to drive
40:13an hour away. Now I
40:15was head of New Brunswick
40:16Heart Center where people in
40:17Canada happily drove five hours
40:19away,
40:19but it's not the case
40:20here in Connecticut. The expectations
40:22are higher. They want care
40:23close to their
40:25home. So, just last week,
40:26Kelsey joined John Forrest in
40:28the clinic in Waterford, and
40:29we wanna have a surgical
40:30presence there at least once
40:32a month, hopefully, to a
40:33cadence of about twice a
40:34month where we can see
40:35some post op visits. And
40:37if it's easier for those
40:38patients to see Kelsey and
40:39John in that clinic, we
40:40wanna provide that to them.
40:42We're not forcing them to
40:43go there, but we want
40:44them to have that as
40:45an option. And the same
40:46thing in Greenwich, we will
40:47hopefully be partnering with our
40:48cardiology colleagues. I think it
40:50always has to be a
40:51partnership, and, hopefully, there, we
40:52can see some of the
40:53patients. But if we can
40:54do that, the onus will
40:56be on us to do
40:56some of the driving, but
40:57I think that's okay. And
40:58if we get more referrals
41:00and we get to provide
41:01better care and more exceptional
41:02care, I think that's good.
41:04In cardiac surgery, we have
41:06a long way to go,
41:07but there are things that
41:07we're trying to do to
41:09create pamphlets, create material to
41:10make it a little bit
41:11easier and better for our
41:13patients to come to us.
41:14And I think there are
41:15a lot of things that
41:15we have to look at.
41:16Now we obviously can't provide
41:18Uber for everybody or free
41:19parking for everybody or have
41:21them stay at the Yale
41:22Suites. But when you have
41:23patients that are potentially coming
41:24in for a double valve
41:25or coming in for those
41:26procedures
41:27that help our our entire
41:30financial well-being,
41:31I think we have to
41:32think a little bit outside,
41:34the box.
41:35We also, I think, have
41:36opportunities to provide better service.
41:38So in terms of our
41:39outreach and and marketing,
41:41you're not seeing a lot
41:42of communications coming out of
41:44us. I think even out
41:45of the heart and vascular
41:46center, we can probably provide
41:47more communication
41:48either, in an email list
41:50serve or a whole bunch
41:51of different ways. We've had
41:52a lot of outreach meetings,
41:54but it's not just good
41:54enough to go for one
41:55meeting. You need to continue
41:57to have those meetings. Every
41:58time I meet cardiologists or
42:00colleagues somewhere else, I find
42:01out a lot of things
42:02that are really important to
42:02them that I had not
42:04even thought about.
42:05We talk about five points
42:06of communication. Ideally,
42:08when we interact with our
42:09cardiology colleagues, there are five
42:11opportunities that we have to
42:12get back to to you.
42:13If we can even maximize
42:14two or three of those,
42:15I think we'll be doing
42:16really well. Right? When you
42:17send us a consult to
42:19acknowledge that we got it,
42:20when we see the patient
42:21in clinic to acknowledge that
42:22we saw that patient, when
42:23we operate on your patient
42:24to tell you how the
42:25operation went, when that patient
42:26is discharged to tell you
42:27how that patient is doing,
42:29especially when they're not doing
42:30well, and when we see
42:31them in clinic and follow-up
42:32after about a month to
42:33tell you what the issues
42:34may or may not be.
42:35Those are the five opportunities
42:36that we have to interact
42:37with you. And the more
42:38that we're able to maximize
42:40those, I think, the better
42:41it'll be.
42:42We've asked our surgeons to
42:43be aware of the rating
42:44sites that are out there.
42:45A lot of them are
42:46independent rating sites, but you
42:48have the power to
42:49to to capture your profile,
42:51to put your photo in
42:52and the things. That's been
42:54very helpful to me in
42:55my career. If you look
42:56up Mark Peltier in health
42:57grades in Cleveland, it'll say
42:59number one out of a
42:59hundred and ten cardiac surgeons
43:01in Cleveland. It's not because
43:02I'm the number one, but
43:03I paid attention to it.
43:04And we've asked
43:05our patients to give ratings
43:07on that, and it's very
43:08powerful. Every clinic I have,
43:09I have patients that come
43:10in and say, oh, I
43:11saw this or I saw
43:12this video or I saw
43:13the ratings. And I think
43:14we need to be aware
43:15that they're out there because
43:17they are out there whether
43:18you want them to be,
43:19or not.
43:20And so, in terms of
43:22operational optimization,
43:24the activity we've talked about,
43:25we don't have a good
43:26sense now in our state
43:28who refers to us and
43:29who does not. We don't
43:30have a great sense in
43:31our
43:32Yale network, the people we
43:33think are in our network,
43:34who's referring to us and
43:36who's not and why they're
43:38not, and maybe we have
43:39a chance to address that.
43:41I think we have the
43:42opportunity to make the process
43:44better for some patients. If
43:46you've ever been to a
43:46structural heart clinic, what's the
43:48average age of those patients?
43:49Right? It's usually eighty. Right?
43:51You know that. It's not
43:52easy for them to come
43:53in. So can we make
43:54that process easier for them?
43:55And increasingly now,
43:57we have those patients on
43:58the surgical side.
44:00In Cleveland, we partnered with,
44:01a company from Canada called
44:03SeamlessMD.
44:04They create an app, and
44:06that app is on our
44:07patient's phone. In Cleveland,
44:09it is that app is
44:10with them every day, every
44:12step of the way from
44:13preop all the way out
44:14to thirty days.
44:16It asks some questions about
44:17how they're doing, what their
44:18pain scores are, things of
44:20that nature.
44:21And our data in Cleveland
44:22is very encouraging. We had
44:23enrolled eleven hundred patients.
44:25Ninety percent activated their accounts,
44:28and eighty nine percent of
44:29them would recommend seamless ND.
44:31When we looked at the
44:32data, we saw our readmissions
44:34after the implementation. So this
44:35was not a randomized trial.
44:37This was simply this is
44:38how we were doing it.
44:39This is what we're doing
44:40now. We saw a significant
44:42drop in our readmissions,
44:43a significant drop in our
44:44emergency room visits,
44:46way fewer phone calls after
44:47hours to our, team,
44:50and our even our discharge
44:51to skilled nursing facility because
44:53patients knew a bit more
44:54what to expect when they
44:55were coming in and leaving,
44:57improved. And we had all
44:58kinds of positive comments about
45:01understanding the concerns, make them
45:02feel better, the consistency of
45:04having somebody there, every day.
45:07We have opportunities to expand
45:09our ECMO and our transplant
45:10program. Our transplant numbers are
45:12down right now, and I
45:13think we have opportunities to
45:14grow that. One of the
45:15opportunities is to expand our
45:17ECMO program. A lot of
45:18ECMO patients
45:21will lead to more heart
45:21failure patients, and I think
45:21we have the opportunity to
45:22do that a little bit
45:23better than we what we've
45:25been doing. But I think
45:26that will also be a
45:27multidisciplinary
45:28effort. I've had a lot
45:29of you, some of the
45:30cardio my cardiology colleagues say
45:31I'd love to be involved.
45:32I'd love to be able
45:33to cannulate.
45:34I I would love that.
45:35We we should expand our
45:36our pool of cannulators. We
45:38have a lot of talented
45:39people who can do that.
45:40But before we do that,
45:41we probably need to tighten
45:42up our mechanism a little
45:43bit as to who do
45:44we put on ECMO, who
45:45do we accept for ECMO.
45:47We need to redevelop a
45:48bit of a shock call.
45:48I need to be on
45:49the phone with some of
45:50my cardiology colleagues at two
45:51in the morning to say,
45:52hey. Is an IMPALA CP
45:54better? Is ECMO better? What
45:55do you think? Sometimes it's
45:57nothing. Sometimes it's it's palliative
45:58care.
46:00I think we have options
46:01in atrial fibrillation. There's a
46:03lot of neat work that's
46:04going on there, but, again,
46:05that has to be a
46:05partnership with the EP. EP
46:08now does tremendous work for
46:09AFib, but there are still
46:10some opportunities, I think, that
46:12we have, to do, better.
46:14I'm gonna skip a little
46:15bit through this because I
46:16do wanna give Kelsey a
46:17a few minutes, and I
46:18I know that we're running
46:19a little bit late on
46:20time, but we'll come to
46:21that in a second.
46:23Our aortic program is excellent.
46:24I mean, really, one of
46:25the stalwarts of the cardiac
46:26surgery program is the work
46:28that Johnny started now that
46:29Prashant,
46:30Roland Ossie, Matt Williams are
46:32doing, Gabe Deluzzo,
46:34on the aortic program. They've
46:36got a surveillance clinic of
46:37eighteen hundred patients that they're
46:39following with enlarged aneurysms.
46:41And I think we have
46:42a lot of opportunities in
46:43terms of our valve procedures.
46:44So,
46:45Arnar, who's a good friend,
46:46did tremendous work here for
46:47many years. His departure was
46:49a big loss for this
46:50institution,
46:52but we've been able to
46:53revamp that. We started in
46:54April. We've already done thirty
46:55minimally invasive procedures in
46:58last few weeks, including several
46:59robotic procedures,
47:01a bunch of complex repairs
47:02involving the anterior posterior leaflet
47:05and bands, and some replacements.
47:07And this is a just
47:08a very short video of
47:09what we see in the
47:10operating room. This was a
47:11case that we did on
47:12Monday. This was,
47:14really by leaflet prolapse because
47:16of severe annular dilation from
47:18commissure to commissure.
47:20This measured forty six millimeters,
47:22if you can imagine. So
47:23this was an undersized thirty
47:24six millimeter ring. And just
47:26by doing that, there's beautiful
47:27coaptation of the anterior and
47:28posterior leaflets.
47:31We look forward to working
47:32with our structural heart colleagues
47:34on some of the new
47:34therapies that are coming up.
47:36Tricuspid valve disease, as you
47:38know, is a very, very
47:39challenging,
47:40entity.
47:41There is a device out
47:42there that's been, FDA approved.
47:44I think we're still in
47:45the phase of trying to
47:46figure out who's gonna benefit
47:47from it. Trials so far
47:49are not showing any mortality
47:50benefit, but they are showing
47:51quality of life improvement. So
47:53I think when you look
47:54at patients with good RV
47:55function who are not frail,
47:57we may see a survival
47:58advantage,
47:59in those patients.
48:01Tendyin, which is a transapical
48:03device, was also approved,
48:04in May. That's something that
48:06we would very much like
48:07to partner with Abbott, on.
48:09That's a transapical device, which
48:10is really just another step
48:12as we get towards transcatheter
48:14mitral valve replacement. It's definitely
48:16not gonna be the final
48:17step mainly because it's transapical,
48:19which is still invasive,
48:21But it's a wonderful technology,
48:22and I think that will
48:24help patients, especially the ones
48:25with, MAC. The MAC data
48:27was just presented at TCT.
48:29It's encouraging.
48:30There's still a high screen
48:31failure rate, but,
48:33that's,
48:34that's where it is. So
48:35I do wanna give my
48:36colleague, doctor Kelsey Gray,
48:38the floor to show you
48:40a little bit of what
48:40she's doing. And what she's
48:42doing is actually really, really
48:44cool.
48:45There are very few people
48:46in the country that are
48:46doing,
48:47robotic mid cap procedures,
48:49and there are even fewer
48:50that are doing what's called
48:52TCAP procedures. So that's a
48:53totally robotic endoscopic procedure.
48:56There's no incision other than
48:57the ports, that are going
48:58in. She did a case,
49:00yesterday.
49:01It was a long case,
49:02complicated patient, two arterial grafts,
49:05totally endoscopic,
49:07all done the nasmosis robotically.
49:09So, if you'll allow me,
49:11I'd like to have, doctor
49:12Kelsey Gray maybe show you
49:13a couple of videos of
49:14some of the cool things
49:15that are going on. Then
49:16after that, we'll have some
49:17time for questions.
49:29Thank you.
49:30If you're not done eating,
49:32stop.
49:33I'm gonna show you some
49:34serious inside of Lottie pictures.
49:36Okay?
49:38Yeah. It was really nice
49:39of Mark to give me
49:40such a nice introduction and
49:41to give me the opportunity
49:43to come here.
49:45It's also nice that he
49:46got he saved, like, the
49:47really showy part and fun
49:48part for me, which is
49:50always extra nice too. Okay.
49:52So,
49:53I was just gonna start
49:54by kind of I I
49:55don't know actually how many
49:56of you have had the
49:57opportunity to go to the
49:58OR and see what we
49:59do. So in order to
50:01really drive home how awesome
50:03some of the minimally evasive
50:04stuff is that we're doing,
50:05I'm gonna show you what
50:06it looks like on a
50:06normal case. So here's a
50:07sternotomy. I don't know if
50:09any of you have ever
50:09seen it.
50:11But we basically just take
50:12a saw
50:14and saw the chest open.
50:16Okay? It's maximally invasive in
50:18every way possible.
50:20This is how we harvest
50:21the mammary. We take these
50:23hooks in, and we
50:24lift up the side of
50:25the chest and show ourselves
50:27the mammary. Right? It's very
50:28invasive. We use this big
50:29metal contraption.
50:32And then, ultimately, we take
50:33a very lovely mammary. So
50:34this is what a skeletonized
50:36mammary looks like harvested off
50:37the chest wall. But you
50:38can see, this is this
50:40is why patients have postoperative
50:41pain. This is why they
50:42struggle to go home. It's
50:43not just the incision itself.
50:45It's what we're doing to
50:46their chest wall. And you
50:48can imagine in older patients,
50:49more frail patients,
50:53malnourished
50:54patients. This leads to rib
50:55fractures,
50:56fractures of the, costochondral
50:58cartilage, all that stuff.
51:01So very maximally invasive. And
51:02then afterwards, we put this
51:04big retractor in, and we
51:05spread the chest wide open.
51:06And we cannulate the or
51:08the aorta and the SVC
51:10and the IVC depending on
51:11what you're doing. And this
51:12just sort of gives a
51:13picture of how many tubes
51:14and lines you can have
51:15running through your heart at
51:16any given time.
51:20But now we can do
51:20it with the robot. A
51:21lot of what we can
51:22do, we can do with
51:23the robot. So I would
51:24say very easily here, we're
51:26in a good position now
51:28to be doing robotic CABG,
51:29robotic mitral valve, robotic aortic
51:32valve,
51:33and we're kind of expanding
51:34that. We can do epicardial
51:35lead placements. We can do
51:36left atrial appendage ligation. We're
51:38hoping to grow that to
51:39be able to do,
51:41some ablations,
51:43convergent procedure, etcetera, etcetera. We're
51:45not quite there yet, but
51:46we're we're basically finding every
51:47way possible to apply the
51:48robot.
51:49And this is what it
51:50looks like. This is me
51:51setting up to do a
51:53robotic mid cab. So you
51:54see our three incisions
51:56right there. If we do
51:57a TCAB, we add, two
51:59extra incisions. You'll get one
52:01for the people on Zoom,
52:02I'm sorry, but you get
52:03one right here and one
52:04right here. This is what
52:06it looks like when we
52:07harvest it robotically. So this
52:08is a bilateral
52:10mammary harvest. So
52:12this is on the right
52:13this is the right internal
52:14mammary artery that I'm harvesting
52:16with the robot. So you
52:16can see you can just
52:17zoom right across the sternum
52:19and take open the the
52:21pleura is still closed on
52:22the you can see the
52:23right lung ventilating there. You
52:24just take down the mammary.
52:26This is a robotic clip
52:27applier putting a clip
52:29on the branch, and then
52:30you just sort of bovie
52:31the branch off the chest
52:32wall. These are kind of
52:33intercostal
52:34branches, basically.
52:36And this is what it
52:37looks like. And so you
52:38can harvest the
52:40right internal mammary artery
52:42and use that as a
52:43conduit. You can either do
52:44it in situ. So you
52:46swing it over, and you
52:46can actually swing it over
52:47and put it on the
52:48LAD, and you can use
52:49the LIMA and take that
52:50to the lateral wall. Or
52:52in this case, I think
52:53for this patient, I actually
52:54took it as a free
52:54graft,
52:56and I took it to
52:56a ramus in this case.
52:58But so I didn't take
52:59as much. I took about
53:00four intercostal
53:01spaces
53:02of
53:03the right.
53:04And then that's what it
53:05looks like. So it's perfectly
53:07skeletonized, and then I move
53:08over to the left. And
53:09here we are starting on
53:10the left. So you just
53:11it's exactly how you would
53:13do it open. You just
53:14go from left to right
53:15instead of from right to
53:16left, and there it is.
53:17There's the left internal mammary
53:19artery.
53:20I kinda sped the video
53:21along, but more or less,
53:22you end up with two
53:24nicely skeletonized
53:25internal mammary arteries.
53:28And then the next step
53:29in the operation after that
53:31when we're doing a regular
53:32mid cab is to go
53:33and I do a posterior
53:34pericardotomy.
53:35And so I look down
53:35at the bottom of the
53:36heart, and this is also
53:37how you'll do a clip.
53:38So here, I just open
53:40the pericardium,
53:41and this allows the the
53:43pericardium to drain into the
53:44left chest at the end
53:45of the case. It also
53:46reduces
53:47the incidence of
53:49postoperative
53:50AFib and some pericarditis.
53:52And so if you're gonna
53:53do the left atrial appendage,
53:55that's the approach there. You
53:56just lengthen that, incision
53:58and show yourself the appendage.
54:00Here is opening the anterior
54:02pericardium, and so this is
54:03how I'm gonna see the
54:04LAD. And so you can
54:05see it. It's right in
54:06there. And so the robot
54:08actually takes away a lot
54:09of, I think, the criticism
54:10associated with doing a traditional
54:11mid cap, which is that
54:13you're very limited in how
54:14you can identify the LAD.
54:16But with the robot, you
54:17can open the pericardium widely.
54:19You can look on the
54:20lateral wall. You can see
54:22a diagonal.
54:23See that diagonal?
54:24And then I can see
54:25that I have the LAD.
54:27The next step here is
54:28to make our incision.
54:30And so this is the
54:30incision that I would do
54:31a traditional beating heart mid
54:33cap through. So on the
54:35left, you can see I
54:37have a stabilizer coming in,
54:39and I use a little
54:40retractor here. I've now moved
54:41away from that, and I'm
54:42doing probably ninety eight percent
54:44of my mid cabs through
54:46with just the soft tissue
54:47retractor through that incision. So
54:48they're not even getting any
54:50ribs spreading.
54:51They do still get the
54:52stabilizer
54:53to put on the heart
54:54through that approach.
54:57And then TCAP. This is
54:58a video. So this is
55:00like a little snippet of
55:01a video that we submitted
55:02to the double ATS,
55:05and this is what TCAB
55:06looks like. So the prep
55:08is still all the same,
55:09same port sites, same everything.
55:13The only difference is is
55:14that instead of making the
55:15anterior mini thoracotomy, we just
55:18stop the heart, and then
55:20I just do everything with
55:21the robot.
55:22So that's the internal mammary
55:24artery. This is just the
55:25isolated LIMA to LAD.
55:27And this is just a
55:29fun little video of so
55:31what it looks like to
55:31sew
55:33the LIMA to the LAD
55:34with the robotic approach.
55:37This is a special double
55:38armed seven o proline,
55:40well, polypropylene
55:41type suture that's made
55:44kind of exclusively for this
55:45purpose, although very few people
55:47really use it. You have
55:48to special order it. It's
55:49only six centimeters long, and
55:51the needle's a lot smaller
55:52than the needle you would
55:53see on a traditional seven
55:54o. The robot really magnifies
55:57everything, so it gives you
55:58really good visualization.
56:00And so here you can
56:01see we're just sewing the
56:03anastomosis like we normally would,
56:05but you can see how
56:06excellent the visualization is. Right?
56:07You can oh, it's kinda
56:08blurry on your screen.
56:11Maybe it's just because it's
56:12so blown up. But the
56:13the visualization is really nice.
56:15So you can see
56:16the wall of the artery.
56:18You could see that precordial
56:19fat. And I always remark
56:20when I'm doing it that
56:21it feels like I'm taking
56:23monstrous bites. But if you
56:24see how minuscule this needle
56:25is, they're actually very fine
56:27bites, and you can even
56:29see you'll see, I think
56:31I believe at the end
56:32of this no. I don't
56:33think so. I think I
56:33edited it out. But when
56:35you watch this plump up,
56:36it's always such nice small
56:37bites that the hood of
56:38the mammary really, like, plumps
56:40up, and you can see
56:41it looks very nice.
56:43So this is just sort
56:43of the technique we use
56:45to do it.
56:47I use a locking suture
56:48in the middle of each
56:49side, to help maintain the
56:49tension because that's one thing
56:49that we do lack when
56:49you do it
56:51robotically.
56:55Robotically is you don't have
56:56anybody following your suture, so
56:57it's hard to harder to
56:59maintain tension.
57:11And then that's what it
57:12looks like when it's all
57:13done. Just tie the suture,
57:15and then we use the
57:17this endo balloon device, which
57:18goes up into the aorta
57:19and includes the aorta. So
57:20we just take the saline
57:22out of the balloon,
57:23reperfuse the heart, and the
57:24heart starts beating at the
57:25end of the case.
57:32And this is what it
57:32looks like. So this is
57:34this is what it looks
57:34like. And pretty much through
57:36this approach, we can do
57:37any any left sided graphs
57:39for the most part. I
57:40think they're very approachable through
57:41this side.
57:43And it's it's a nice
57:45option for patients. Not every
57:46patient can have this surgery.
57:48Some patients,
57:49you can't really have a
57:50diseased aorta. You can't have
57:52aneurysm in your aorta. You
57:53can't really you can have
57:55mild AI. We have workarounds.
57:57We can do a retrograde
57:58cannula through the right IJ,
58:00which will allow us to
58:01get retrograde cardioplija to arrest
58:02the heart, which is actually
58:03what we did yesterday for
58:04this patient who has osteogenesis
58:07imperfecta.
58:08So,
58:09there's there are some constraints
58:11over who can have this
58:14TCAB surgery as it stands
58:15right now, but
58:17I think it's it's relatively
58:19broadly applicable to people. You
58:20can't have severe peripheral vascular
58:22disease because we have to
58:23cannulate your peripheral arteries.
58:26You wanna have relatively preserved
58:28ejection fraction because we're gonna
58:29arrest your heart. That being
58:31said, for the people who
58:32can't have a TCAB, a
58:33mid cab is still a
58:34really great option. It's a
58:36beating heart surgery. It reduces
58:37your risk of stroke. It's
58:39for people who have, you
58:40know, people who have really
58:42severely reduced ejection fractions
58:44can do very well with
58:45it because we're not arresting
58:46the heart. We're not really
58:47manipulating the heart very much.
58:48We're not compressing the heart
58:50too much. So it's a
58:51really great option.
58:54And then this is sort
58:55of what it looks like
58:56for a robotic aortic valve
58:57setup, and we're gonna do
58:58our first robotic aortic valve
59:00case tomorrow
59:02here. And,
59:04like Mark said, we've done
59:05this the mitral setup is
59:06very similar to this. And
59:08like Mark said, I we've
59:09done six
59:10robotic mitrals, I think. I
59:12believe six robotic mitrals. They've
59:14all gone very well.
59:17We the team here has
59:18not really forgotten how to
59:19do robotics, so it's been
59:20really incredible working with everybody
59:22and working with the team
59:23that really knows what they're
59:24doing. So this is what
59:25it looks like. You can
59:26basically, for the incision for
59:28a robotic,
59:30aortic valve or robotic mitral,
59:32small mini thoracotomy,
59:34third intercostal space,
59:36the robotic trocars,
59:38and then I have a
59:39little video. So I have
59:40this is these are just
59:42kinda tiny little shorts because
59:43it's hard to show you
59:44an entire,
59:46aortic valve surgery because you
59:47end up looking through a
59:49lot of sutures and all
59:50this stuff. But this is
59:51a,
59:52fibroblastoma
59:53that I resected, and that's
59:54the case that we're actually
59:55gonna start with tomorrow.
59:57So this is a case
59:58that I've done in the
59:59past.
60:00So you can see the
01:00:00aorta's open. You get a
01:00:02great view of the aorta
01:00:03and the aortic valve.
01:00:05There's our fibroblastoma.
01:00:08And just use these tiny
01:00:09sharp little pot scissors to
01:00:11go in. So you can
01:00:12zoom all the way in
01:00:14there. So another thing that
01:00:15I think we're gonna eventually
01:00:16try and work towards is
01:00:17doing,
01:00:18once we kind of get
01:00:19a robust aortic valve program,
01:00:22we're gonna try and work
01:00:23towards probably doing robotic
01:00:25septomyectomies
01:00:26as well because you can
01:00:27see you can just zoom
01:00:28right in there. And then
01:00:29this is what a,
01:00:31this is what it would
01:00:31look like if the valve
01:00:32was in there instead. So
01:00:34this is a valve that
01:00:35we've already put in. We've
01:00:36tied down a handful of
01:00:37the sutures along the right
01:00:38and the left,
01:00:40and there's just sort of
01:00:40the sutures along the noncoronary,
01:00:44that are left. But
01:00:46it's also a very nice
01:00:47approach for an aortic valve.
01:00:50That's all I have.
01:01:03Oops. Oh.
01:01:07Well, great.
01:01:08We've we've kept you here
01:01:09really right at the hour.
01:01:11Thank you very much for
01:01:12giving us the audience today.
01:01:14Happy to take any questions
01:01:15if we have a minute
01:01:16or two, but, thanks again.
01:01:20Thanks, Mark. It's fantastic. I
01:01:21work.
01:01:22Please help everyone,
01:01:24we'll I'll be again.
01:01:28So
01:01:31I think we, and maybe
01:01:32one or two questions. So
01:01:34particularly for Chelsea,
01:01:36Bill Chelsea is the help
01:01:37of Mark. So can you
01:01:39help guide our cardiology team
01:01:41in terms of, hybrid fluasmodation?
01:01:44When is the right what
01:01:45is the right patient
01:01:46refer
01:01:47for,
01:01:48you know, for,
01:01:51you know, hybrid approach?
01:01:53And have you started doing
01:01:53that when you when you
01:01:55envisioned,
01:01:56start there? I can maybe
01:01:58take that first. I think,
01:01:59two weeks ago, we had
01:02:00our first chip meeting,
01:02:01which is really, I think,
01:02:02a key component of that
01:02:03is working with our interventional
01:02:05cardiology
01:02:06colleagues to have those discussions,
01:02:08because I think there are
01:02:09some patients that
01:02:10clearly are gonna do better
01:02:12with multi
01:02:13grafting, you know, standard sternotomy
01:02:15and all that. There are
01:02:16clearly some patients that are
01:02:17better with PCI and should
01:02:18not have surgery. But there's
01:02:20a mix of patients in
01:02:21there that we all recognize
01:02:23as a cardiology and cardiac
01:02:24surgery community that the limits
01:02:25of the LAD,
01:02:27especially in a diabetic, has
01:02:28value from a survival perspective.
01:02:31But
01:02:32we don't have any good
01:02:33trials or evidence in cardiac
01:02:35surgery that grafting, a surgical
01:02:36grafting in RCA improves survival.
01:02:39So if our cardiology colleagues
01:02:40can get a good stent
01:02:42on those vessels, they may
01:02:43be a good candidate for
01:02:44for hybrid. So I think
01:02:46they have to be individualized.
01:02:47They are discussions that need
01:02:48to happen. I think we
01:02:50have a sense sometimes of
01:02:51what our cardiology colleagues can
01:02:52do, but I don't always
01:02:54know. So it's really important
01:02:55to have those conversations,
01:02:57and and get their input.
01:03:12And so I think that's
01:03:13the key. Right? It's, like,
01:03:15trying to you have to
01:03:16fit you
01:03:18have to offer what's the
01:03:19right operation and the right
01:03:21intervention
01:03:22to the right patient. You
01:03:23know? You can't kind of
01:03:24make everything fit one like,
01:03:26make a patient always fit
01:03:27an operation or an operation
01:03:29always fit a patient. I
01:03:30think that's where these multidisciplinary
01:03:32discussions really come into play.
01:03:34There's gonna be patients that
01:03:36can have you know, we
01:03:37can hopefully do
01:03:38three vessels,
01:03:40all
01:03:41robotic
01:03:41grafting too, and there's gonna
01:03:43be other patients that are
01:03:44not gonna be suitable for
01:03:45that procedure, but they may
01:03:46be a really great candidate
01:03:47for a LIMA to LAD,
01:03:49off pump, feeding, heart, followed
01:03:51by stage PCI. Or they
01:03:53come in and they're a
01:03:54super high risk candidate, but
01:03:55they're having
01:03:57they're having STEMI
01:03:59to their lateral wall, but
01:04:00they have proximal LAD disease
01:04:02that they don't wanna treat
01:04:03right then. Right? Now you
01:04:05have to decide if you
01:04:06wanna wait for that patient
01:04:08to, you know, kind of
01:04:09recover. You're gonna not treat
01:04:11their STEMI because they have
01:04:12LAD disease, or you're gonna
01:04:13stent full things. These are
01:04:14patients that you can stent
01:04:15the culprit lesion,
01:04:17wait four weeks, and we
01:04:18can bring them back, and
01:04:19we can give them surgical
01:04:20LIMIT to LAV without having
01:04:22to do a sternotomy for
01:04:23it. And I think it
01:04:23opens just another it's just
01:04:25another tool in the toolbox.
01:04:26And so you just have
01:04:27to figure out who to
01:04:28apply.
01:04:29Wonderful. I mean, I think
01:04:30the tool we have now,
01:04:32are
01:04:34it's up to thirty twenty
01:04:35years ago when hybrid, we
01:04:36have to get you to.
01:04:38Any other parts on that?
01:04:41I'm sure.
01:04:42Think I could have done
01:04:42a little bit of picture.
01:04:44So thank you both. This
01:04:45has been wonderful and a
01:04:46breath of fresh air working
01:04:47with you, Mark, and and
01:04:49and, looking forward to working
01:04:50with you as well.
01:04:51As we talk about training
01:04:53environments, we've had just a
01:04:54really great collaboration over the
01:04:56course of decades between cardiology
01:04:58and and surgery,
01:05:00with the ISECS program and
01:05:01other opportunities. And I was
01:05:02just wondering if you could
01:05:02speak to what your vision
01:05:04is in those spaces. There
01:05:05seems like there's just a
01:05:06a myriad of great opportunities
01:05:08for both, cardiology and and
01:05:10CT surgery trainees to get
01:05:12involved with the hybrid procedures
01:05:13and different,
01:05:14different, set care settings.
01:05:17Yeah. I I would say
01:05:18the training program is one
01:05:20of the major reasons that
01:05:21I came to Yale. I
01:05:22I I love the I
01:05:23six residency program, the people
01:05:25that are in it.
01:05:27And I think we have
01:05:28the op opportunity to train
01:05:30amazing surgeons that are gonna
01:05:32go in the future.
01:05:34The the interplay of cardiology
01:05:35is vital to that. Right?
01:05:37We see it in structural
01:05:38heart. We see it in
01:05:39transplantation.
01:05:40I mean, those were the
01:05:41original heart teams, if you
01:05:42will, especially on the transplant
01:05:44side then in terms of
01:05:45structural heart. So it's very
01:05:47important that our surgical residents
01:05:48get, that expertise and get
01:05:50that experience. And it's important
01:05:52also whenever we can to
01:05:53have some of the cardiology,
01:05:54of the cardiology, trainees work
01:05:56with us whenever they wanna
01:05:57come and work with us.
01:05:58So, I think for us,
01:06:01the the challenging part is
01:06:02the environment that we're in.
01:06:04When I when I trained,
01:06:05there was a lot of
01:06:06triple bypass, aortic valve triple
01:06:08bypass.
01:06:08These poor residents are not
01:06:10exposed to as much of
01:06:11that. Like, they're coming in
01:06:12sometimes double valve redo, aortic
01:06:14arch redo,
01:06:15complex heart transplant on an
01:06:17LVAD. And so giving them,
01:06:19things that within a course
01:06:20of a case that they
01:06:21can do is sometimes a
01:06:22little bit of a challenge.
01:06:23But in cardiac surgery, a
01:06:25lot of those things are
01:06:26divided
01:06:26into a lot of so
01:06:27you you don't need to
01:06:28do the whole case, but
01:06:29maybe this case, you do
01:06:30the sternotomy, you harvest the
01:06:31mammary, you cannulate,
01:06:32maybe here you threw throw
01:06:34a few valve sutures here
01:06:35or there. So that's a
01:06:37challenge, but training in the
01:06:38next generation, it's imperative that
01:06:40we do that. I would
01:06:41tell you that we are
01:06:42doing well. Our our residency
01:06:44program on the last match,
01:06:46by the estimates of the
01:06:47ACGME based on where people
01:06:49ranked and all that, we
01:06:49were fourth in the country.
01:06:51We got, only our top
01:06:52five picks in all training
01:06:54spots that we were looking
01:06:55at, which is remarkably different
01:06:57than I think where we
01:06:58sat a few years ago.
01:06:59So we're on
01:07:00tremendous upswing on that in
01:07:02that regard.
01:07:04Great. Also, like to see
01:07:05us move to have our
01:07:06residents and fellows
01:07:08cross train, as well in
01:07:10not only in the units,
01:07:11but also in the imaging
01:07:12labs and have our cardiac
01:07:14cardiology fellows go into the
01:07:16OR, which I think is,
01:07:18what we haven't done here
01:07:19in a while. So
01:07:21any other questions?
01:07:24If not, I know it's
01:07:24late in the hour. Maybe
01:07:25one last, Stefania.
01:07:33Alright. Thank you so much.
01:07:34We are for the cardiovascular
01:07:36resource center
01:07:37basic scientist, and it was
01:07:39kinda tough to watch this
01:07:40movie, but it was also
01:07:42illuminating.
01:07:44The precision,
01:07:45the Chelsea show is amazing.
01:07:47For us, we immediately
01:07:49are thinking about tissue collection,
01:07:51sample, blood, anything that can
01:07:53be potentially harvest for
01:07:56research and,
01:07:57expression of candidate on biological
01:07:59question. So how do you
01:08:00think about that?
01:08:02We would love to partner
01:08:03with you. We have several
01:08:05basic scientists in our group
01:08:06that are taking
01:08:07aortic samples coming in at
01:08:09three in the morning on
01:08:10a Saturday to get a
01:08:11get an aortic sample. So
01:08:13I'm very dedicated. We'd love
01:08:14to work with you on
01:08:15on that. That's the easy
01:08:16part. There's always tissues discarded
01:08:19if it's of value to
01:08:20you and your research,
01:08:22and we're consented and all
01:08:23that stuff properly.
01:08:25Absolutely. We'd be happy to.
01:08:26So talk to me, reach
01:08:27out, and happy to link
01:08:29you with some of our
01:08:30researchers as well. And it's
01:08:31Devine has built a great
01:08:33tradition because George Teledite was
01:08:35has been an important
01:08:37collaborator,
01:08:38with our CBRC for decades,
01:08:40and I think, we wanna
01:08:41build on that. So wonderful.
01:08:43Well, everyone, thanks for coming,
01:08:45and thanks again for our
01:08:46speakers.