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.

After years of being omitted from clinical trials, research is finally taking strides to recognize the specificity of heart disease in women. Dr Sharon Mulvagh joins Dr Bernard Gersh to ask why wouldn't there be differences in heart disease between women and men. Evidence now shows that what was once dismissed as a "false positive"—when a woman presents symptoms in a functional study but no evidence of anatomic constructive coronary disease—may indicate microvascular disease and be reason for great concern. Learn more.

Despite the ever shrinking size of devices and our greater technical expertise, there has been a disproportionate rise in the rate infections associated with cardiac devices. Drs Raul Espinosa and M Rizwan Sohail join Dr Charanjit (Chet) Rihal to discuss the possible explanations and best known measures to keep infection at bay. They review types of infections, how diagnosis is made, the thorny issue of TEE, and practical suggestions for extraction and reimplantation of devices.

Which patients are the best candidates for heart transplantation? Drs Sudhir Kushwaha and Rocky Daly—respectively the medical and surgical directors of the Heart Transplantation and VAD therapy program at Mayo Clinic—review the steps to selecting patients for transplantation and discuss ventricular assist devices (as bridge-to-transplantation and destination therapy) and the listing system that categorizes those awaiting surgery.

Research on spontaneous coronary artery dissection (SCAD) at the Mayo Clinic is a telling example of "patient-initiated" research made possible by social media. Dr Sharonne Hayes discusses with Dr Sharon Mulvagh the genesis of the SCAD project and the tremendous opportunities of the initiative, as well as the challenges posed by this new mode of interaction. Hear more about the powerful role that an online support group can play in finding answers for rare diseases and ultimately how social media can help shape research.

Popular treatment options fail to recognize AF as a consequence of other problems and instead attempt to treat atrial fibrillation as if it were the problem itself. Dr Jim Seward joins Dr Chet Rihal to share his approach to preventing and treating AF. What role can ACE inhibitors and ARBs play?

Dr Veronique Roger joins Dr Bernard Gersh to review the latest data and share insight into what is now termed an epidemic. They examine the diversification of cases, the thorny issue of hospital readmissions, differences between multimorbidities and comorbidities, how to address end-of-life care, and why it's essential to establish a holistic approach to HF.

Dr Vuyisile Nkomo is joined by Dr Joseph Dearani for an update on the latest information pertaining to surgical valve repair—which valves fare best, why repair is better than replacement, novel surgical approaches, where to have repair done and risks, and the role of imaging in successful surgery.

What's the latest on the surgical treatment of thoracic aortic disease? Dr Juan Bowen catches up with Dr Alberto Pochettino on issues such as safety of surgical procedures and when to refer a patient for surgery, as well as an update on aortic-valve procedures and a review of technical advances in the field.

Thanks to important improvements in care, more than 85% of people with congenital heart disease are surviving well into adulthood. What is the best method to continue caring for these patients? Dr Joseph Dearani joins guest host Dr Naser Ammash to review treatment options and the healthcare professionals best suited to implement them and discuss the ideal of an integrated approach to care..

Trends in the US (and the developed world) point to a radical change in the patterns of acute MI—as shown by both a decrease in CV mortality and STEMI. Epidemiologist Dr Veronique Roger joins Dr Bernard Gersh to review these patterns, what factors are causing them, and why they are dissimilar in developing countries.

Where do things stand with hormone-replacement therapy? Dr Sharon Mulvagh joins Dr Bernard Gersh to shine light on the notoriously complicated data including the HERS, WHI, KEEPS, and DOPS trials and show why the trial results are not as contradictory as they might appear.

Despite more than 40 years of research, our understanding of this field remains limited. Dr Douglas Packer joins the show to discuss the pathophysiology of atrial fibrillation in regard to the targets for radiofrequency ablation, how the procedure has changed in the past 15 years, and what complications are associated with the procedure. How will the CABANA trial contribute to the discourse?

Dr Bernard Gersh asks Dr Samuel Asirvatham about the syndromes that categorize patients who have ventricular tachycardia in the absence of structural heart disease and what the treatment options—including ablation—are for these patients.

Guest host Dr Margaret Redfield discusses the basics of left ventricular assist devices (LVADs) as bridge to transplant, destination therapy, and bridge to recovery with leading heart-failure surgeon Dr Soon Park. What role are LVADs playing in HF at the moment and what does the future hold?