Auxanö Medical | Dr. Julius Kwedhi

Aortic Stenosis | Pt 1 | Dr. Julius Kwedhi | Auxanö Medical Podcast

Aortic Stenosis | Pt 1 | Dr. Julius Kwedhi | Auxanö Medical Podcast Every cardiovascular surgeon knows Aortic Stenosis demands profound judgment. Are you ready for the most comprehensive, evidence-anchored deep dive into AS, guided by the latest 2025 ESC/EACTS and Russian RACVS/RSC guidelines? From microscopic anatomy to the nuances of low-flow, low-gradient subtypes, this episode is designed to be your ultimate reference, whether you're in the OR, a Heart Team meeting, or prepping for boards. Plus, Dr. Julius shares a vital Wisdom Nugget to ground your practice in discernment. Key Topics Covered: * The Aortic Valve: Microscopic Anatomy & Surgical Pearls: A deep dive into the three cusps, histological layers (fibrosa, spongiosa, ventricularis), the virtual annulus, sinuses of Valsalva, and the critical fibrous skeleton. Essential knowledge for every surgeon. * Pathophysiology & Natural History: Understanding calcific degenerative AS, bicuspid aortic valve, and rheumatic heart disease etiologies. Explore LV concentric hypertrophy, impaired coronary flow reserve, and the canonical natural history data (Ross & Braunwald). * Clinical Presentation & Physical Examination: The classic symptom triad (angina, syncope, dyspnoea), pulsus parvus et tardus, ejection systolic murmur (including Gallavardin phenomenon), S2 splitting, S4 gallop, and the critical Heyde syndrome. * Diagnostic Workup & Severity Grading: ECG findings, chest X-ray, and the cornerstone of diagnosis: transthoracic echocardiography. Mastering the 2025 ESC/EACTS numerical thresholds for severe AS. * Decoding Low-Flow Low-Gradient AS: Distinguishing classical vs. paradoxical LFLG AS, the role of dobutamine stress echo, and the critical utility of CT calcium scoring (with sex-specific thresholds). * Medical Management — What Works & What Doesn't: The definitive truth about pharmacological therapy in AS, managing hypertension and fluid overload, and the cautious use of beta-blockers. Includes a special focus on Russian clinical practice for anticoagulation. * Wisdom Nugget: Dr. Julius reflects on Proverbs 3:5-6, 24:3, and 4:7, emphasizing humility, understanding, and divine wisdom in complex surgical decision-making. Podcast Order: * Introduction: Welcome to Auxanö Medical Podcast & Episode Overview * Dr. Julius’s Wisdom Nugget: Proverbs for the Cardiac Surgeon * Section One: Anatomy of the Aortic Valve and Root (Microscopic to Macroscopic) * Surgical Anatomy Pearl: 5 Things Every Surgeon Must Know About the Aortic Root * Section Two: Pathophysiology and Natural History of Aortic Stenosis * Natural History: Commit These to Memory (Ross & Braunwald Data) * Section Three: Clinical Presentation and Physical Examination * Section Four: Diagnostic Workup and Severity Grading (2025 Guidelines) * Severity Grading Thresholds: 2025 ESC/EACTS Guidelines & LFLG Subtypes * Section Five: Medical Management — What You Need to Know * Pharmacological Management Reference & Russian Clinical Context Don't miss a single beat! Subscribe to Auxanö Medical Podcast on Apple Podcasts, Spotify, Google Podcasts, or wherever you get your medical insights. Follow Dr. Julius Kwedhi on YouTube and LinkedIn for more cardiovascular surgery discussions and updates. Grow in your medical knowledge with us!

The Ozaki Procedure: A Deep Dive into Aortic Valve Neocuspidization (AVNeo) | Dr. Julius Kwedhi | Auxanö Medical Podcast

Episode Title: The Ozaki Procedure: A Deep Dive into Aortic Valve Neocuspidization (AVNeo) Prepare for an electrifying journey into the future of cardiac surgery! Dr. Julius Kwedhi is thrilled to unravel the Ozaki Procedure (AVNeo) – a revolutionary technique transforming how we approach aortic valve disease. From microscopic anatomy to the latest 2025/2026 evidence, discover why this innovation is a game-changer for patients worldwide. Key Topics Covered: * Aortic Valve Anatomy & Pathology: A foundational review of the aortic valve and root, encompassing stenosis, regurgitation, rheumatic, calcific, bicuspid disease, and endocarditis. * Clinical Presentation & Diagnosis: Detailed discussion of physical examination findings and the complete diagnostic workup, including 2025 ESC/EACTS grading thresholds. * Medical Management & Intervention Criteria: Evidence-based approaches to medical management (specific drugs, doses, routes) and Class I/IIa indications for surgical intervention. * The Ozaki Procedure (AVNeo): * Historical context and evolution. * Step-by-step operative technique, including the brand-new third-generation New Ozaki Procedure (2025). * Comparative outcomes against Ross procedure, conventional SAVR, and TAVI. * Application in special populations: children, pregnant patients, dialysis patients. * Global relevance: insights from LMIC, sub-Saharan African, and Russian clinical contexts. * Future directions and anticipated advancements over the next decade. Guest Info: N/A (Host-led episode with Dr. Julius Kwedhi) Structure: * Introduction: The Excitement of AVNeo * Aortic Valve & Root: The Anatomical Foundation * Disease Spectrum: Stenosis, Regurgitation, Bicuspid & More * Clinical Presentation & Diagnostic Workup (2025 Guidelines) * Medical Management & Intervention Indications * The Ozaki Procedure: History & Core Principles * Step-by-Step Operative Technique & The New Ozaki (2025) * Comparative Outcomes: Ozaki vs. Ross, SAVR, TAVI * Special Populations & Global Context (LMIC, Russia) * The Future of AVNeo: What's Next? * Clinical Pearls, Conclusion & Key Takeaways Subscribe CTA: Whether you're preparing for board exams or refining your surgical practice, this episode offers a comprehensive, evidence-based command of the Ozaki Procedure. Don't miss out on vital medical knowledge! Subscribe to Auxanö Medical Podcast | Dr. Julius Kwedhi on all major podcast platforms, share this episode with a colleague, and leave us a review!

Aortic Regurgitation | Dr. Julius Kwedhi | Auxanö Medical Podcast

Aortic Regurgitation | Dr. Julius Kwedhi | Auxanö Medical Podcast In this episode, Dr. Julius Kwedhi breaks down everything you need to know about aortic regurgitation — one of cardiovascular surgery's most nuanced conditions. Whether you are a fellow preparing for boards, a consultant refreshing your practice, or a surgeon building a cardiac programme in a resource-limited setting, this episode covers the full clinical and surgical spectrum. What we cover: We open with the remarkable history of AR — from Dominic Corrigan's 1832 description in syphilitic aortitis to the rich legacy of eponymous signs that still define the bedside examination today. The water-hammer pulse, De Musset's head bob, Quincke's nail-bed pulsations, Duroziez's to-and-fro femoral murmur, the Austin Flint rumble — each sign is explained with its physiological mechanism and real clinical utility. We then move through pathophysiology: why the volume-overloaded ventricle tolerates AR for decades but eventually reaches a point of no return, and why that irreversible myocardial fibrosis — not the valve itself — is what ultimately kills these patients if surgery is delayed too long. We discuss the 2025 ESC/EACTS guidelines in detail, including the most clinically important changes: the new Class IIa thresholds for earlier surgery in asymptomatic patients (LVESDi >22 mm/m², LVESVi >45 mL/m², LVEF ≤55% in low-risk patients), the divergence with the 2021 ACC/AHA guidelines on the LVEF threshold for Class I surgery (50% vs 55%), and — the biggest news — the first-ever guideline recognition of transcatheter therapy for native AR, awarded Class IIb on the back of the ALIGN-AR trial. The ALIGN-AR trial is covered in full: 500 patients, 28 US centres, the JenaValve Trilogy's leaflet-grasping anchor mechanism, 96.4% device success, 1.4% thirty-day mortality, zero cases of moderate or greater paravalvular regurgitation at one year, and the FDA approval that followed in March 2026 — a genuine paradigm shift for inoperable patients. On the surgical side, we go deep on the Ross procedure — why the 25-year CARNET registry data and the 24-year Harefield RCT follow-up both show general-population-equivalent survival, and why a network meta-analysis now confirms the Ross outperforms both mechanical and bioprosthetic valves for mortality in young adults. We discuss external autograft reinforcement as the technical advance that may resolve late autograft dilation. We cover the David reimplantation versus Yacoub remodelling debate, including the 2024 meta-analysis demonstrating superior survival and freedom from reoperation with reimplantation. A dedicated segment addresses the sub-Saharan African context: rheumatic AR presenting at age 15 to 45, the REMEDY registry data, the anticoagulation dilemma for mechanical valves in settings with unreliable INR monitoring, why the Ross procedure is the optimal solution for young LMIC patients, and the practical role of benzathine penicillin G prophylaxis in preventing recurrent valvular damage. We close with the drugs: the 24-agent pharmacology table explained — ACE inhibitors, ARBs, dihydropyridines, loop diuretics, MRAs, SGLT2 inhibitors including the DapaTAVI results — and the absolute contraindications in acute severe AR that every surgeon and intensivist must know: no IABP, no beta-blockers, and no delay. Key references discussed: 2025 ESC/EACTS Guidelines (EHJ 2025;46:4635); ALIGN-AR (Lancet 2025;406:2757); CARNET Ross Registry (JACC 2021;77:1412); Harefield post-hoc RCT (JAMA Cardiol 2024;9:6); El-Hamamsy propensity-matched series (JACC 2022;79:805); David 20-year series (JTCVS 2021;161:890); REMEDY Registry (EHJ 2015;36:1115). Periodic new episodes. Subscribe, share with a colleague, and leave a review. Listen to Auxanö Medical Podcast | Dr. Julius Kwedhi on all major Podcast Platforms.

Chronic Mesenteric Ischemia | Pt 2 | Dr. Julius Kwedhi | Auxanö Medical Podcast

🎙Chronic Mesenteric Ischemia | Pt 2 | Dr. Julius Kwedhi | Auxanö Medical Podcast Welcome to Auxanö Medical Podcast with Dr. Julius Kwedhi, your number one Cardiovascular surgery podcast where you grow in your medical knowledge. Email: juliuskwedhi@zoho.com [juliuskwedhi@zoho.com] YouTube: Julius Kwedhi MD, MPH [https://www.youtube.com/@KwedhiMD] @KwedhiMD [https://www.youtube.com/@KwedhiMD] https://www.youtube.com/@KwedhiMD [https://www.youtube.com/@KwedhiMD] Telegram Channel: Dr. Julius Kwedhi, MD🫀 [https://t.me/drjuliuskwedhi] @DrJuliusKwedhi [https://t.me/drjuliuskwedhi] https://t.me/drjuliuskwedhi [https://t.me/drjuliuskwedhi]

Chronic Mesenteric Ischemia | Pt 1 | Dr. Julius Kwedhi | Auxanö Medical Podcast

🎙Chronic Mesenteric Ischemia | Pt 1 | Dr. Julius Kwedhi | Auxanö Medical Podcast Welcome to Auxanö Medical Podcast with Dr. Julius Kwedhi, your number one Cardiovascular surgery podcast where you grow in your medical knowledge. Email: juliuskwedhi@zoho.com [juliuskwedhi@zoho.com] YouTube: Julius Kwedhi MD, MPH [https://www.youtube.com/@KwedhiMD] @KwedhiMD [https://www.youtube.com/@KwedhiMD] https://www.youtube.com/@KwedhiMD [https://www.youtube.com/@KwedhiMD] Telegram Channel: Dr. Julius Kwedhi, MD🫀 [https://t.me/drjuliuskwedhi] @DrJuliusKwedhi [https://t.me/drjuliuskwedhi] https://t.me/drjuliuskwedhi [https://t.me/drjuliuskwedhi]