DAIC May-June 2011

DAIC May-June 2011 Digital Edition
Key Highlights From ACC 2011
April 11, 2011 — The following is a roundup of key news and trial data that came out of the American College of Cardiology (ACC) 2011 Scientific Session in New Orleans last week. Transcatheter Valve Repair Performs Very Well
Converting From CAD to PAD
As medicine continues its march away from open surgical procedures to minimally invasive and transcatheter treatments, the cath lab has opened up to new treatment areas beyond the coronaries. Peripheral artery disease (PAD) in the legs has traditionally been the territory of vascular surgeons, but there has been a major transition to transcatheter PAD procedures in the past 10 years, blurring the lines between surgeons and interventionalists.
Review of the RIVAL Trial
The RIVAL trial shows there is no difference in rates of composite death, myocardial infarction, stroke or major bleeding between radial access and femoral access strategies, but radial access decreased major vascular complications.
Radial Angiography and Intervention Abstracts From ACC and i2 Summit
There were 15 abstracts presented describing radial access and intervention during the American College of Cardiology (ACC) and i2 Summit meeting in April in New Orleans. The abstracts focused on some of the most burning issues in current radial research.
3-D/4-D Echo Allows Faster Workflow, Increased Accuracy
The biggest trend in cardiovascular ultrasound is the adoption of 3-D/4-D echo systems for better images, more data, better measurement quantification and faster workflow. Other key trends include software to speed workflow with fewer keystrokes and to enhance quantification, miniaturization, increased use of tissue strain imaging and expanded use for operating room and cath lab procedures.
Physicians Struggle With When to Use OCT
Imaging technology and diagnostic tools for interventional cardiologists have changed dramatically over the past few years with the introduction of optical coherence tomography (OCT), improvements in intravascular ultrasound (IVUS) and pressure guide wires used in fractional flow reserve (FFR). Product innovation and integration of these technologies, as well as a growing base of clinical evidence, are transforming the way physicians diagnose, treat and follow-up patients undergoing percutaneous coronary intervention (PCI).
The Advantages and Disadvantages of OCT vs. IVUS
There are many advantages to using optical coherence tomography (OCT) intravascular imaging. However, interventionalists should not rush to trade in their intravascular ultrasound (IVUS) systems, said Michael R. Jones, M.D., FACC, director of the Central Baptist Hospital Heart and Vascular Institute, Lexington, Ky.
Choosing Tools for Transradial Procedures
When a lab is transitioning from transfemoral to transradial cardiac catheterizations, the process can be either encouraging or discouraging to all staff involved. To ease the transition, it might be useful to employ previously implemented ideas, techniques and equipment selections that have had positive outcomes. This article will discuss patient preparation, equipment selection and address common inventory concerns that occur when developing a transradial catheterization program. The ideas and initiatives discussed in this article are those that we undertook at the Jesse Brown VA Medical Center in Chicago and may not reflect other cath labs’ setup. However, most of the concepts are applicable to all catheterization labs.
Door-to-Balloon Times: 60 Minutes or Less
According to the American College of Cardiology (ACC), each year nearly 400,000 patients are admitted to U.S. hospitals with ST segment elevation myocardial infarction (STEMI). National ACC/American Heart Association (AHA) guidelines state that hospitals treating STEMI patients with emergency percutaneous coronary interventions (PCI) should reliably achieve a door-to-balloon time (D2B) of 90 minutes or less, and studies have demonstrated strong associations between time to primary PCI and in-hospital mortality risk.
Sealing the Access Site
For decades, cath lab clinicians essentially had only one option for achieving hemostasis management following a procedure – compression. That changed in the 1990s with the introduction of vascular closure devices and hemostatic pads, which were designed to significantly shorten the time it took to close the wound left at the access site.
Silos Being Abolished With Current Generation CVIS
Only a few years ago, separate software systems without a common interface were the industry standard to manage electrocardiograms (ECGs), hemodynamic monitoring systems in the cath lab, picture archiving and communications systems (PACS), electrophysiology, cardiac ultrasound and other areas of cardiac specialty.
Cardiac Regeneration After MI: Role of the Extracellular Matrix
Over the last decade, cardiac stem cell therapy has shown tantalizing but as yet unrealized potential as a treatment for the left-ventricular dysfunction (LVD) that develops subsequent to myocardial infarction (MI). Experimentally, somatic stem cells of various lineages, as well as pluripotent stem cells, have been induced to transform into contractile myocytes expressing cardiac-specific proteins.
Resurrecting Dead Heart Tissue
For years researchers have experimented with stem cells in attempts to regrow myocardium in patients who suffer permanent tissue damage from myocardial infarction. A handful of companies are pushing forward with clinical trials of their technologies in an effort to show this futuristic concept has promise.