Hello, and welcome back to ACRAC. I'm Jed Wolplot, and I'm absolutely thrilled because I have back with me today two former superstar guests, Dr. Michael Osando and Dr. Joe Cody.

They you may remember used to work together at the Ohio State University where Dr. Osando is still a professor of anesthesiology and the assistant dean for graduate medical education.

But Dr. Cody as these things happened graduated from fellowship. I'm sure with flying colors and is now down in Florida in the warm weather where he's a cardiac anesthesiologist in the community setting at quite a busy center doing hearts and a lot of other things.

I'm going to ask him to tell us a little bit about that in a second. I do just want to remind everyone that ACRAC now offers CME credit. So if you want or need CME, you can go to the website, click on the links for CME and get it that way.

All right, let's jump in. We're going to talk about the Mitra clip procedure, how that works, why it's being done. This is if you don't know and we'll learn a lot more about it, but is a new way of managing

mitral valve disease. And I'm really excited to learn more about it and share that with all of you. So Joe and Mike, welcome back to the show.

Thanks for having us, Chad. Thanks for having us again. It's always an honor and a privilege to be an ICRAC.

Thanks so much. All right. So I want to start though, Joe, by asking you tell us a little bit about that transition because I'm sure there are folks out there listening who are fellows now or residents going to be fellows thinking about that transition from fellowship to private practice and just talk a little bit about, you know, what that was like for you, how you picked where you are and what you're doing, what your practice looks like now.

Yeah, sure. So I was trained by Mike at Ohio State. So my transition was pretty smooth because of basically because of the good training that I got there. And as a resident through alganian and Pittsburgh. And I wanted a job where I could do a fair bit of cardiac, but I felt like I spent so much time in training doing OB and regional and

and in a piece and all those stuff though. So I wanted a job where I could use my fellowship. And so they brought me in as kind of a cardiac eye. So that's kind of where they stick me most days. So I usually do

one to three pump cases for like either either valve or cabbage surgery or or similar per week. And then other days I'm placed in, I'm taking care of patients in the structural heart settings. So that would be either tabbers at watchman's microclips.

That kind of group of procedures. And then if they don't have that going on, I'm doing OB or peeds or ortho or so I get to do a little bit of everything, but mostly cardiac and it's really great because it was kind of the perfect job for me.

We have residents that rotate through. It's not really a residency, but I still kind of get to teach too. So for me, it's kind of been the perfect job. I don't think I'll ever be a full professor in dean of GME like Mike, but I get to do what is good for me. And it's a good fit for me. So yeah.

That's great. Well, I'm thrilled. And I think, you know, really good for people to realize that there are so many different paths to interesting careers into happiness. Right. So really, thanks for sharing that.

Let's jump in. Mike, maybe we'll start with you. If you could talk a little bit about maybe just review with us, mitral regurgitation. You know, what is it? What does it mean? What kind of hemodynamic complications are associated with it? And that, of course, is going to take us into the mitral clip, which is a treatment for mitral regurgitation.

But let's start with just a review of mitral regurgitation. What do you think it's important for people to know to understand our discussion to come?

Excellent. I think that's a great way to start. So I'll start off by saying that to really grasp a great understanding of mitral regurgitation. It's important to understand what the mitral valve is made of. So the mitral valve is different from the aortic valve. The aortic valve is essentially the leaflets, the analysts and that's about it.

The mitral valve on the other hand is a complex. So it's made up of the leaflets, the commissures, then you have cordy tendony that attach the leaflets to the popular muscle.

So then after the popular muscle, you have the underlying ventricle. And so any dysfunction of any of these components, even include in the left atrial walls. If you have left atrial enlargement, it would lead to a dilation of the analyst that will lead to mitral regurgitation.

If you have somebody who has an acute myocardial infarction and they develop a popular muscle rupture, that will lead to mitral regurgitation. So if you have a patient, we developed global ventricle dysfunction.

Or even if you have a desynchrony of the left ventricle from right ventricle or a patient, that would also lead to mitral regurgitation. So mitral regurgitation essentially is a heterogeneous disease and the ideologies can be due to any dysfunction of any of these components.

And essentially if you go by the strict classification for, you know, classifying the classification of mitral regurgitation, there are two types. You have the primary mitral regurgitation, which is a disease of the leaflets themselves and other sources may call it organic.

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