Mayo Clinic Talks theheart.org

For several decades, rheumatologists have documented the elevated risk for cardiovascular disease of patients with autoimmune disorders such as rheumatoid arthritis and lupus, but it has only relatively recently entered the cardiovascular literature. In this episode, Drs Sharon Mulvagh and Rekha Mankad discuss the role that inflammation appears to play in disease, what special treatment and additional screening for CV risk is appropriate for this patient set, and how the guidelines are changing to incorporate those with autoimmune disorders.

Having discussed patient selection for transplantation in their previous recording, Drs Sudhir Kushwaha and Rocky Daly—respectively the medical and surgical directors of the heart transplantation and ventricular assist device (VAD) therapy program at Mayo Clinic, turn their attention to management of the patient in the perioperative and postoperative setting. In a rapidly changing field, they share their expertise with the latest options in immunosuppressive strategy and thoughts on the long-term management of those who have had a transplant.

With over 30 years of procedural experience, the surgical repair of the mitral valve has become the gold standard for the treatment of severe mitral regurgitation. Dr Rakesh Suri joins Dr Hector Michelena to discuss the genesis of the minimally invasive robotic approach to mitral-valve repair with tips on timing, safety, and a review of the relative advantages of the newer approach.

Dr Harold Burkhart joins Dr Frank Cerra to review the use of robotics and other minimally invasive techniques in congenital heart patients. They discuss the origins of robotic surgery, the patients for whom the procedures are appropriate and what they involve, as well as the rise of hydrid procedures—involving both catheter-based technologies and surgery—and treatment for hypoplastic left heart syndrome.

Drs Chet Rihal and Kevin Greason share Mayo Clinic's expertise in transcatheter aortic-valve replacement with insight intended for centers embarking on new programs. Among topics, they discuss: the key determinants of prognosis, the learning curve, addressing the risk of perioperative stroke, appropriate antiplatelet and anticoagulant therapies, access sites, and the importance of the "preflight check list."

After showing promising results in early-phase trials for ischemic heart disease, stem-cell therapy is now being examined as a possible mechanism to treat congenital diseases such as hyperplastic left heart syndrome. Drs Harold Burkart and Timothy Nelson discuss researchers' efforts to understand the origins of congenital heart diseases and how regenerative therapies might one day fit into this framework.