Discussions about the most relevant topics in cardiothoracic surgery from CTSNet, the Cardiothoracic Surgery Network.
Episodes
Thursday Nov 06, 2025
Thursday Nov 06, 2025
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Liam Burns, CEO of Qaelon Medical, about turning ideas into companies.
Chapters
00:00 Intro
02:26 JANS 1, Ross Procedure Consensus Statement
13:59 JANS 2, Novel Anastomotic Device
16:03 JANS 3, Tracheobronchoplasty Disorders Analysis
18:32 JANS 4, Revasc Strategies Non-Acute Myocardial
20:22 JANS 5, EACTS Core Curriculum for Cardiac Surgeon
21:51 Video 1, Giant Right Coronary Artery Aneurysm
24:01 Video 2, Bentall-de Bono Procedure
25:29 Video 3, Democratizing MI Mitral Repair
27:01 Liam Burns Interview
37:15 Upcoming Events
38:38 Closing
They explored the challenges faced by innovators and emphasized the importance of having a commercial perspective. Additionally, they discussed product design, the fundraising process, and the challenges that commercial leaders face. Burns also shared valuable advice for aspiring innovators.
Joel also highlights recent JANS articles on the EACTS expert consensus statement on the Ross procedure in adult patients, a human cadaver study on a novel anastomotic device for the sandwich technique in type A aortic dissections, a comparative analysis of distinct airway disorders, revascularization strategies for non-acute myocardial ischemic syndromes, and core curriculum for the cardiac/cardiovascular surgeon.
In addition, Joel explores the surgical repair of a giant right coronary artery aneurysm with saphenous vein interpositional grafting, the Bentall-de Bono procedure, and democratizing minimally invasive mitral repair. Before closing, Joel highlights upcoming events in CT surgery.
JANS Items Mentioned
1.) EACTS Expert Consensus Statement on the Ross Procedure in Adult Patients
4.) Revascularisation Strategies for Non-Acute Myocardial Ischaemic Syndromes
CTSNet Content Mentioned
3.) Democratizing Minimally Invasive Mitral Repair
Other Items Mentioned
1.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani
2.) Case of the Month: The Case of a Foreign Body
3.) Resident Video Competition
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Thursday Oct 30, 2025
Thursday Oct 30, 2025
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning explores the integration of artificial intelligence (AI) in writing medical articles.
Chapters
00:00 Intro
01:56 Using AI in Medical Writing
09:07 JANS 1, AI-Writing Article
14:53 JANS 2, Kidney vs Lung Transplant Outcomes
17:04 JANS 3, Harvesting Tech on ITAG
18:56 JANS 4, Phase 2 NeoCOAST-2 Trial
23:01 Career Center
23:41 Video 1, TAVR Explant After CABG w MVR
25:28 Video 2, Updated Y-Incision AA Enlargement
27:05 Video 3, Carotid Artery Cann for CABG
28:16 Upcoming Events
He reviews guidelines set by the International Committee of Journal Editors Committee regarding publication ethics and emphasizes the benefits of utilizing AI in writing processes. Joel also highlights the crucial necessity of including disclosures when employing AI tools. Additionally, he delves into other ways AI can be used, such as data analysis, and discusses taking accountability when using these technologies. Furthermore, he addresses the limitations of AI, noting that it cannot be cited as a source or used as a coauthor.
Joel also highlights recent JANS articles on assisted artificial intelligence in medical writing, the impact of kidney transplantation on survival outcomes for lung transplantation, if the harvesting technique affects the production of nitric oxide and endothelin in the internal thoracic artery graft, and the platform phase 2 NeoCOAST-2 trial on perioperative durvalumab plus chemotherapy plus new agents for resectable non-small-cell lung cancer.
In addition, Joel explores a TAVR explant after CABG with MVR, tips and tricks for the updated Y-incision aortic annular enlargement, and carotid artery cannulation for cardiopulmonary bypass in minimally invasive cardiac surgery.
JANS Items Mentioned
1.) Assisted Artificial Intelligence in Medical Writing: A Primer for Humans
2.) The Impact of Kidney Transplantation on Survival Outcomes for Lung Transplantation
CTSNet Content Mentioned
1.) TAVR Explant After CABG With MVR
2.) Tips and Tricks for the Updated Y-Incision Aortic Annular Enlargement
3.) Carotid Artery Cannulation for Cardiopulmonary Bypass in Minimally Invasive Cardiac Surgery
Other Items Mentioned
2.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani
3.) Resident Video Competition
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Thursday Oct 23, 2025
Thursday Oct 23, 2025
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Fraser Sutherland, a consultant cardiac surgeon at Ross Hall Hospital and the Golden Jubilee National Hospital, Scotland, about the world’s first transcervical robotic aortic valve replacement (AVR) procedures.
Chapters
00:00 Intro
02:30 JANS 1, CABG After 60 Years
13:53 JANS 2, Endovascular Arch Repair
16:45 JANS 3, Impact of Age on ARR
18:47 JANS 4, Anterior Mediastinal Teratomas
20:28 Career Center
21:02 Video 1, RUL Without Dissecting SPV
22:58 Video 2, Replacement w Double Patch Repair
23:53 Video 3, TAVR & SAVR Removal w LVOR
24:47 Dr. Sutherland Interview
45:26 Closing
They discuss the history and evolution of these cases, along with the preclinical work that led to this innovative technique. Dr. Sutherland addresses initial challenges such as the uniportal incision, the transcervical retractor system, and enhancing dexterity by incorporating a robotic system. They also detail the first clinical case, including postoperative outcomes and the importance of maintaining safety for the patient. Additionally, they explore the benefits for patients undergoing this procedure and its future potential. Furthermore, Dr. Sutherland provides insights into the procedural steps and key aspects of the procedure.
Joel also highlights recent JANS articles on coronary artery bypass grafting 60 years after its debut, endograft design options and worldwide results for endovascular arch repair, the impact of age on aortic root replacement, and a multicenter retrospective study on if subxiphoid thoracoscopic surgery is safe and feasible for the treatment of anterior mediastinal teratomas.
In addition, Joel explores a multiportal approach for robotic right upper lobectomy without dissecting the superior pulmonary vein, aortic and mitral replacement with double patch repair, and TAVR and SAVR removal with left ventricular outflow reconstruction.
JANS Items Mentioned
1.) Coronary Artery Bypass Grafting: 60 Years After Its Debut
2.) Endovascular Arch Repair: Endograft Design Options and Worldwide Results
3.) The Impact of Age on Aortic Root Replacement
CTSNet Content Mentioned
2.) Aortic and Mitral Replacement With Double Patch Repair
3.) TAVR and SAVR Removal With Left Ventricular Outflow Reconstruction
Other Items Mentioned
2.) Resident Video Competition
3.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Thursday Oct 16, 2025
Thursday Oct 16, 2025
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Marc Pelletier, division chief of cardiac surgery for the Department of Surgery at Yale School of Medicine, about patient blood management.
Chapters
00:00 Intro
01:45 EACTS 2025
07:19 JANS 1, HVD Management Guidelines
16:26 JANS 2, Low-Risk AVR Evidence
19:21 JANS 3, Warden Procedure Selection
20:36 JANS 4, Primary Repair of CAT
21:48 JANS 5, NEWTON-CABG Cardiolink-5
23:20 Video 1, Acute Aortic Syndrome
24:54 Video 2, Redo TVR Under Bypass
27:13 Video 3, Giant Tension Bulla
28:47 Dr. Pelletier Interview
34:25 Outro
They delve into the Society of Thoracic Surgeons (STS) guidelines on patient blood management, along with key tips. They also explore preoperative optimization, provide an example, and discuss cell savers and reducing dead space during surgery. Additionally, they touch on postoperative transfusion and the importance of performing meticulous surgery.
Joel also highlights recent JANS articles on the 2025 ESC/EACTS guidelines for the management of valvular heart disease, low-risk aortic valve replacement at the crossroads of evidence, ideal age and weight for the Warden procedure in patients with partial anomalous pulmonary venous return, a systematic meta-analysis of short- and long-term outcomes of the primary repair of common arterial trunk, and an international, randomized, double-blind, placebo-controlled trial on the effect of Evolocumab on saphenous vein graft patency after coronary artery bypass surgery.
In addition, Joel explores the surgical treatment of acute aortic syndrome, a redo tricuspid valve replacement technique under right heart bypass for a previously repaired tricuspid valve, and thoracoscopic resection of a giant tension bulla. Before closing, Joel highlights upcoming events in CT surgery.
JANS Items Mentioned
2.) Low-Risk Aortic Valve Replacement at the Crossroads of Evidence
CTSNet Content Mentioned
1.) Surgical Treatment of Acute Aortic Syndrome
3.) Thoracoscopic Resection of a Giant Tension Bulla
Other Items Mentioned
1.) STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management
3.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Thursday Oct 09, 2025
Thursday Oct 09, 2025
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning shares insights from his recent trip to Ghana.
Chapters
00:00 Intro
02:18 Ghana Mission Trip
04:35 Failures of a Heart Surgeon
09:27 JANS 1, Accelerometer-Measured Physical Activity
12:57 JANS 2, Utility of GERAADA Score
14:41 JANS 3, Aortic Valve Neocuspidization
17:33 JANS 4, Procedural Planning in Thoracoscopic Segmentectomy
19:09 JANS 5, The Outlet Orifice Diameter
22:28 Video 1, Clampless Aortic Valve Replacement
24:01 Video 2, Multiportal Robot-Assisted Extended LLS S6
25:13 Video 3, The Atrium
26:00 EACTS 2025 & Upcoming Events
27:35 Footage From Ghana
He discusses the various procedures that he and his team performed during their visit, as well as his overall experience collaborating with the local surgeons. The episode also features surgical footage from his time in Ghana and includes discussion with several surgeons about their work. Additionally, Joel addresses a recent news story from the UK regarding the failures of a heart surgeon that have contributed to multiple patient deaths. He provides an overview of the circumstances surrounding these events and emphasizes the critical importance of teamwork in surgical practice.
Joel also highlights recent JANS articles on an analysis of the UK mini mitral randomized controlled trial for accelerometer-measured physical activity after mitral valve surgery, the utility of GERAADA score for predicting long-term survival following surgical repair of aortic dissection, early to mid-term results of aortic valve neocuspidization for rheumatic aortic valve disease, a systematic review and meta-analysis for three-dimensional reconstruction and virtual simulation of patient-specific anatomy for procedural planning in thoracoscopic segmentectomy, and the outlet orifice diameter of surgical bioprosthetic aortic stented valves is predominantly much smaller than the inlet orifice diameter.
In addition, Joel explores a clampless aortic valve replacement in a partial porcelain aorta with aortic root enlargement and CABG with two grafts, multiportal robot-assisted extended lower left segmentectomy, and an episode of The Atrium podcast featuring host Dr. Alice Copperwheat speaking with Dr. John D. Puskas about proximal coronary anastomosis. Before closing, Joel highlights upcoming events in CT surgery.
JANS Items Mentioned
3.) Early to Mid-Term Results of Aortic Valve Neocuspidization for Rheumatic Aortic Valve Disease
CTSNet Content Mentioned
3.) The Atrium: Proximal Coronary Anastomosis
Other Items Mentioned
1.) Joel Dunning YouTube Channel | The Arrhythmia Alliance Hearts of Ghana Mission 2025
2.) Heart Surgeon’s Failures Contributed to Multiple Deaths
4.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Thursday Oct 02, 2025
Thursday Oct 02, 2025
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Anders Jeppsson, a cardiothoracic surgeon at Sahlgrenska University Hospital in Gothenburg, Sweden, about his paper on “Ticagrelor and Aspirin or Aspirin Alone After Coronary Surgery for Acute Coronary Syndrome,” published in The New England Journal of Medicine.
Chapters
00:00 Intro
01:54 Ghana Mission Trip
06:23 JANS 1, Pig-to-Human Transplant
08:08 JANS 2, CABG Acute Type A AD
10:06 JANS 3, Chylothorax Lymph Node Management
11:22 JANS 4, ICU Resternotomy Adoption
13:38 JANS 5, Octogenarians Repair vs MV Surgery
15:10 Career Center
15:31 Video 1, MVR Patent Bilateral IMammary Grafts
16:36 Video 2, Repeat RA Thoracotomy
17:39 Video 3, Vascular Injuries in Robotics
19:12 Dr. Jeppsson Interview
33:30 EACTS 2025 & Upcoming Events
They began by providing an overview of the study, including the reason for conducting it, the expansion of the study to other Nordic countries, and its results. They also discuss the funding for the research and the recruitment process. Additionally, they cover dual antiplatelet therapy and compare this study with similar research. Finally, they explore registry-based studies and future research on ticagrelor and aspirin, or aspirin alone, following coronary surgery for acute coronary syndrome.
Joel also highlights recent JANS articles exploring whether protective coronary artery bypass grafting improves surgical outcomes in acute type A aortic dissection with coronary ostial involvement, the association of chylothorax with aggressiveness of lymph node management during pulmonary resection, if intensive care unit resternotomy should be practiced in all facilities that perform cardiac surgery, transcatheter edge-to-edge repair vs mitral valve surgery in octogenarians, and research using pig-to-human lung xenotransplantation into a brain-dead recipient.
In addition, Joel explores robotic mitral valve replacement in a patient with patent bilateral internal mammary grafts, repeat right axillary thoracotomy as a safe and feasible approach for repair of recurrent LAVVR after previous AVSD repair, and handling vascular injuries in robotic thoracic surgery. Before closing, Joel highlights upcoming events in CT surgery.
JANS Items Mentioned
5.) Pig-to-Human Lung Xenotransplantation Into a Brain-Dead Recipient
CTSNet Content Mentioned
Other Items Mentioned
1.) Ticagrelor and Aspirin or Aspirin Alone After Coronary Surgery for Acute Coronary Syndrome
2.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Tuesday Sep 30, 2025
Tuesday Sep 30, 2025
In this episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. John Puskas, professor of surgery at Emory University, Chief of Cardiothoracic Surgery at Emory University Hospital Midtown, and Wilton Looney Director at the Emory Carlyle Fraser Heart Center in Atlanta, Georgia, USA, about proximal coronary anastomosis.
Chapters
00:00 Intro
00:44 About Dr. Puskas
03:35 Background & History
06:56 10 Commandments for PA
10:34 When to Do It?
13:57 Aorta Site Selection
19:32 Step-by-Step
29:21 Sewing Onto Aorta
33:15 Variations & Alternatives
44:50 Key Messages
46:08 Advice to Trainees
They discuss the 10 principles for proximal anastomosis during coronary artery bypass grafting, saphenous vein grafts vs free arterial grafts, as well as the optimal site selection on the aorta. They also explored key aspects of preparation and arteriotomy, and highlighted various variations and alternatives, such as clampless techniques and sequential grafting. Additionally, they examined the pitfalls and complications associated with proximal coronary anastomosis and the future of proximal coronary anastomosis.
The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Watch for next month’s episode on aortic dissection with Dr. Marc Moon.
Related Resources
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Thursday Sep 25, 2025
Thursday Sep 25, 2025
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Drs. Daniel Brockman, Professor of Small Animal Surgery at The Royal Veterinary College, London, England, and Matteo Rossanese, Senior Lecturer in Small Animal Surgery at The Royal Veterinary College, about performing cardiothoracic surgery in animals.
Chapters
00:00 Intro
01:44 Innovation Competition Results
07:18 JANS 1, Modified Bio-Bentall
08:45 JANS 2, External Aortic Root
11:53 JANS 3, Re-Redo Pulm Valve
13:19 JANS 4, Tracheal Regeneration Model
16:15 Career Center
16:56 Video 1, EXIT-to-Open Atrial Septectomy
17:16 Video 2, Incision Repair of Tetra Fallot
19:40 Video 3, Isolated Pulm Leaflet Autograft
22:33 Dr. Brockman and Rossanese Interview
51:11 Upcoming Events
53:30 Closing
They explore the evolution of cardiothoracic surgery in veterinary medicine, discussing a variety of cases and the techniques employed, including mitral valve repair. Additionally, they highlight the anatomical differences between animals and humans, explaining how surgical techniques must be adapted accordingly. They also cover methods for testing valves, measuring the quality of repairs, and monitoring postoperative outcomes and follow-ups. Furthermore, they touch upon various conditions, such as tetralogy of Fallot, heart valve defects, etc.
Joel also highlights recent JANS articles on modified Bio-Bentall operation with a rapid deployment valve, personalized external aortic root support, clinical success of re-redo pulmonary valve and pulmonary trunk homograft replacement during the second trimester of pregnancy, and lessons learned from various 3D-printed tracheal grafts in an extensive porcine model for de novo tracheal regeneration.
In addition, Joel explores an EXIT-to-open atrial septectomy for hypoplastic left heart syndrome with intact atrial septum, incision of the moderator band during repair of tetralogy of Fallot, and a new solution for aortic valve repair, isolated pulmonary leaflet autograft. Before closing, Joel highlights upcoming events in CT surgery.
JANS Items Mentioned
1.) Modified Bio-Bentall Operation With A Rapid Deployment Valve
2.) Personalized External Aortic Root Support: The Dutch Experience
CTSNet Content Mentioned
2.) Incision of the Moderator Band During Repair of Tetralogy of Fallot
3.) Isolated Pulmonary Leaflet Autograft: A New Solution for Aortic Valve Repair
Other Items Mentioned
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Thursday Sep 18, 2025
Thursday Sep 18, 2025
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Alexis Shafii, professor of surgery and surgical director of heart transplantation at The Texas Heart Institute at Baylor College of Medicine, about the first in-human BiVACOR total artificial heart implantation.
Chapters
00:00 Intro
01:54 JANS 1, Validation of SYNTAX
04:58 JANS 2, Long-Distance ECMO Bridge
09:05 JANS 3, Segmentectomies Made Easy
10:49 JANS 4, MI Total Arterial BG
12:56 Career Center
13:46 Video 1, MI ASD Closure
15:43 Video 2, Basics of MV Surgery
17:03 Video 3, Construct Autologous P MV
20:19 Dr. Shafii Interview
33:37 Upcoming Events
34:56 Closing
They discuss the preclinical work and the history behind the development of this innovative device. Dr. Shafii also showcases the device and explains its functionality in detail. They also highlight the first patient who received the BiVACOR total artificial heart implantation and provide insights into learning the nuances of this operation. Additionally, they explore the critical aspects of explanting the device and the importance of understanding how to explant the heart. Furthermore, they discuss the next steps for gaining approval of the BiVACOR total artificial heart, including the feasibility trial, and speculate on where we might be in five years regarding total artificial heart implantation.
Joel also highlights recent JANS articles on the external validation of SYNTAX score II in a real-world cohort undergoing coronary artery bypass grafting, successful extracorporeal membrane oxygenation bridge to lung transplant with a patient transported from Hawaii to Nashville, Tennessee, USA, robotic-assisted left S3 segmentectomy, and minimally invasive total arterial bypass grafting via left minithoracotomy in obese patients.
In addition, Joel explores direct cannulation for minimally invasive ASD closure, an instructional video for residents on the basics of mitral valve surgery, and how to construct an autologous pericardial mitral valve for infants and small children. Before closing, Joel highlights upcoming events in CT surgery.
JANS Items Mentioned
3.) Segmentectomies Made Easy Series: Robotic-Assisted Left S3 Segmentectomy
4.) Minimally Invasive Total Arterial Bypass Grafting via Left Minithoracotomy in Obese Patients
CTSNet Content Mentioned
1.) Minimally Invasive ASD Closure: Direct Cannulation
2.) Basics of Mitral Valve Surgery: An Instructional Video for Residents
3.) How to Construct an Autologous Pericardial Mitral Valve for Infants and Small Children
Other Items Mentioned
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Thursday Sep 11, 2025
Thursday Sep 11, 2025
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Adanna Akujuo, a cardiothoracic surgeon and the surgical director of the Structural Heart Program at UVA Health University Medical Center, about the Voom Foundation and its trips to Africa.
Chapters
00:00 Intro
01:39 Dr. Akujuo, Medical Missions
21:57 JANS 1, Ticagrelor and Aspirin Coronary
25:20 JANS 2, Long-Term MVR Durability Model
27:37 JANS 3, Duration of Donor Ventilation
29:18 JANS 4, Min Inv Concomitant Tri VR
31:40 JANS 5, Soft Robotic Artificial Hybrid Heart
33:32 Career Center
34:20 Video 1, RVOT Injury During Dissection
37:05 Video 2, Min Inv ASD Closure
38:31 Video 3, Redo AVR via Partial U Resternotomy
40:08 Upcoming Events
40:54 Closing
They explore the foundation’s goals, including training and educating local medical staff and providing essential care. Additionally, Dr. Akujo offers insights into the upcoming trip, discussing what a typical day entails, transportation logistics, accommodation, and the expenses that surgeons participating in the trip will need to cover, as well as what costs are taken care of by the foundation. The conversation also covers security measures in place, the average number of staff members on these trips, the daily surgical volume, and the most common cases.
Joel also highlights recent JANS articles on which is best, ticagrelor and aspirin or aspirin alone after coronary surgery for acute coronary syndrome; an artificial intelligence and machine learning model for personalized prediction of long-term mitral valve repair durability; effect of duration of donor ventilation on lung transplant outcomes; surgical decision-making for concomitant tricuspid valve repair in minimally invasive mitral valve surgery; and a soft robotic total artificial hybrid heart.
In addition, Joel explores right ventricular outflow tract injury during deep dissection in valve-sparing aortic root replacement, a minimally invasive approach for atrial septal defect closure, and redo aortic valve replacement via partial upper resternotomy. Before closing, Joel highlights upcoming events in CT surgery.
JANS Items Mentioned
1.) Ticagrelor and Aspirin or Aspirin Alone After Coronary Surgery for Acute Coronary Syndrome
3.) Effect of Duration of Donor Ventilation on Lung Transplant Outcomes
5.) A Soft Robotic Total Artificial Hybrid Heart
CTSNET Content Mentioned
2.) Minimally Invasive Approach for Atrial Septal Defect Closure
3.) Redo Aortic Valve Replacement Via Partial Upper Resternotomy
Other Items Mentioned
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.