Leadership and Scholarship
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1 Leadership and Scholarship Unintended Consequences, Unexpected Benefits Hartzell Schaff, M.D. American Association for Thoracic Surgery May 6, MFMER slide-1
2 Samuel Robinson 1922 Carl A. Hedblom 1924 Stuart W. Harrington 1938 O. Theron Clagett MFMER slide-2
3 John W. Kirklin 1979 Dwight C. McGoon 1984 Robert B. Wallace MFMER slide-3
4 Minneapolis Rochester 2013 MFMER slide-4
5 2013 MFMER slide-5
6 2013 MFMER slide-6
7 2013 MFMER slide-7
8 G. Rainey Williams Lazar J. Greenfield Ronald C. Elkins 2013 MFMER slide-8
9 2013 MFMER slide-9
10 Vincent L. Gott Robert K. Brawley Timothy J. Gardner 2013 MFMER slide-10
11 Mayo Clinic Rochester Saint Marys Hospital 2013 MFMER slide-11
12 Division of General Thoracic Surgery Mayo Clinic 2013 MFMER slide-12
13 Division of Cardiovascular Surgery Mayo Clinic 2013 MFMER slide-13
14 2013 MFMER slide-14
15 American Association for Thoracic Surgery Leadership Scholarship 2013 MFMER slide-15
16 2013 MFMER slide-16
17 2013 MFMER slide-17
18 John C. Maxwell on Leadership Evolving from authority to persuasion Position is a poor substitute for influence 2013 MFMER slide-18
19 2013 MFMER slide-19
20 Characteristics of True Leadership Adhere to the values of your group Be an expert in the group Vision and plan execute the plan Elevate group s interest over your own Be a role model 2013 MFMER slide-20
21 2013 MFMER slide-21
22 G. Rainey Williams 2013 MFMER slide-22
23 2013 MFMER slide-23
24 American Association for Thoracic Surgery Leadership Scholarship 2013 MFMER slide-24
25 Benefits of Scholarship in Thoracic Surgery Career advancement, obtaining residency/fellowship Discovery and recognition of work through presentation and publication Lead to a career as a surgeon/scientist Unexpected benefit 2013 MFMER slide-25
26 Earl H. Wood 2013 MFMER slide-26
27 2013 MFMER slide-27
28 418 Photo, ca. 1942, of Mayo Clinic's Human Centrifuge 2013 MFMER slide-28
29 2013 MFMER slide-29
30 2013 MFMER slide-30
31 2013 MFMER slide-31
32 2013 MFMER slide-32
33 2013 MFMER slide-33
34 2013 MFMER slide-34
35 H.J.C. Jeremy Swan, M.D MFMER slide-35
36 2013 MFMER slide-36
37 2013 MFMER slide-37
38 Isolated Heart Preparation and Perfusion Apparatus Overflow Water jacket Reservoir Oxygenator Heat exchanger Pump Perfusate column Inflow Thermistor in pulma Mass spectrom. probe Aorta To strain gauge LA LV 2013 MFMER slide-38
39 Isolated Heart Preparation Thermistor Pacing electrode Ao Mitral annulus To be suture to mitral annulus Balloon to event Mass spectrom. probe PA Remnant of atrial wall Tubing from LV balloon to strain gauge LV Balloon 2013 MFMER slide-39
40 Return of Ventricular Function in the Reperfusion Period % Percent Recovery of Developed LV Pressure Arrest 1 hr LV balloon reinflated 27 KCI KCI 37 Reperfusion Minutes Circulation. Vol 58, No 2, August MFMER slide-40
41 Percent Recovery of Max dp/dt Paralleled Recovery of Developed Pressure % Arrest 1 hr Percent Recovery of dp/dt max LV balloon reinflated 27 KCI KCI 37 Reperfusion Minutes Circulation. Vol 58, No 2, August MFMER slide-41
42 LVEDP (mm Hg) Increase in LVEDP After 45 Minutes Reperfusion *P<0.05 vs KCL KCL * Circulation. Vol 58, No 2, August MFMER slide-42
43 Schaff et al: Am J Physiol, MFMER slide-43
44 Dp/dt max (% control) Recovery of Maximum Developed Pressure and dp/dt max During Reperfusion 100 * * * = P<0.001 vs Reperfusion time (min) Schaff et al 2013 MFMER slide-44
45 Ped (mm Hg) Left Ventricular End-Diastolic Pressure (P ed ) During Reperfusion * 22 * Reperfusion time (min) * = P<0.05 vs 37 Schaff et al 2013 MFMER slide-45
46 Post arrest myocardial H 2 O content Myocardial H 2 O Content After 1 Hour Ischemic Arrest and 45 Minutes of Reperfusion * = P<0.001 vs 37 * Schaff et al 2013 MFMER slide-46
47 P ed (mm Hg) End-Diastolic Pressure (P ed ) vs End-Diastolic Volume (V ed ) Postarrest V ed (ml) Prearrest In P ed 10 Postarrest =1.195 = V ed (ml) Prearrest =1.107 = MFMER slide-47
48 Patient (no.) Myectomy for HCM Mayo Clinic N=2, MFMER slide-48
49 A B C D E F 2013 MFMER slide-49
50 Diastolic Dysfunction in HCM 2013 MFMER slide-50
51 A B C D E F 2013 MFMER slide-51
52 Apical HCM LV apex hypertrophied in Asia (25%) vs West LV relaxation diastolic dysfunction Atrial fibrillation 2013 MFMER slide-52
53 HCM Diastolic Dysfunction Stiffer P ed = e V ed P ed Normal V ed 2013 MFMER slide-53
54 HCM Diastolic Dysfunction Stiffer P ed = e V ed P ed Normal V ed 2013 MFMER slide-54
55 HCM Apical Myectomy 2013 MFMER slide-55
56 Technique of Apical Myectomy 2013 MFMER slide-56
57 Apical HCM 2013 MFMER slide-57
58 Technique of Apical Myectomy 2013 MFMER slide-58
59 Apical Myectomy Clinical Experience 62 pt Sept 93 to Jan 13 Age 50±17 yr, 66% women All had dyspnea, 61% angina, 59% syncope 91% class III or IV LVOT obstruction in 9 pt 2013 MFMER slide-59
60 2013 MFMER slide-60
61 Hemodynamics Premyectomy Postmyectomy 2013 MFMER slide-61
62 LVEDP (mm Hg) End-Diastolic Pressure at Catheterization P=0.007 Preoperative mean Preoperative Predismissal or late Dismissal or late mean 2013 MFMER slide-62
63 Indexed LVEDV (ml/m2) End-Diastolic Volume by Ventriculography P=0.003 Preoperative mean Preoperative Predismissal or late Dismissal or late mean 2013 MFMER slide-63
64 Pressure (mm Hg) LV Pressure Volume SV EDP Volume (ml) 2013 MFMER slide-64
65 Pressure (mm Hg) LV Pressure Volume SV Preop Postop EDP Volume (ml) 2013 MFMER slide-65
66 22 y/o male Apical and midventricular HCM Sedentary with exertional dyspnea and angina Unresponsive to beta blockers, calcium channel blockers, nitrates, and ranolazine 2013 MFMER slide-66
67 2013 MFMER slide-67
68 Patient s mother We believe if Justin s quality of life improves to the point where he can regain some mobility and spend a few hours of the day out of bed, the surgery can be counted as a success MFMER slide-68
69 2013 MFMER slide-69
70 Justin Vigile # MFMER slide-70
71 2013 MFMER slide-71
72 2013 MFMER slide-72
73 2013 MFMER slide-73
74 American Association for Thoracic Surgery Leadership Scholarship 2013 MFMER slide-74
75 2013 MFMER slide-75
76 2013 MFMER slide-76
77 2013 MFMER slide-77
78 2013 MFMER slide-78
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