During the American College of Cardiology 2013 (ACC.13) annual meeting in March, vendors discussed several trends they are observing in the cardiac ultrasound market and displayed the latest echo advances.
Philips introduced CX50 xMatrix architecture designed to support advanced fluoro integration with the EchoNavigator system. It aligns TEE views with live fluoroscopy to enhance navigation in complex structural heart procedures. Transesophageal echo (TEE).
A 3-D Philips TEE image from the iE33 xMatrix system showing an atrial septal defect closure device after transcatheter deployment. Transesophageal echo (TEE)
Philips' live 3-D TEE view of a mitral valve balloon valvuloplasty. Transesophageal echo (TEE)
Philips' live 3-D TEE view of a mitral valve balloon valvuloplasty. Transesophageal echo

The development of 3-D transesophageal echo (TEE) just a few years ago has enabled a new generation of interventional procedures to be performed, which otherwise would have been extremely difficult or impossible. With live 3-D TEE, physicians can see cardiac structures and function, as well as real-time displays of the beating heart, from new perspectives. 
STEMI, Aspirus

The Aspirus Heart & Vascular Institute (AH&VI) services 14 counties in north central Wisconsin and an additional seven counties in the Upper Peninsula of Michigan.  The institute receives patients from five hospitals within its system and approximately 10 other hospitals from within this service area. With such a large, mostly rural population — patients come from as far away as 80 miles or more — the organization needed to find a way to more efficiently serve its ST-elevation myocardial infarction (STEMI) and heart valve repair patients. 

When cath labs begin performing radial access procedures, both the staff and the operators need to keep an open mind and recognize that it takes time for everyone in the lab to become proficient in doing things in a different way. Learning a new skill can take time and dedicated effort, and as long as one recognizes that, a fledgling transradial program can flourish rather than be abandoned. We offer the following tips for consideration based on our own experience.

There is a growing trend in the use of small, portable extracorporeal membrane oxygenation (ECMO) systems for hemodynamic support. In years past, ECMO systems were a tool of the operating room, primarily for bypass surgery. Older systems required a perfusionist to watch the machine 24 hours a day while it was in operation. Today’s ECMOs use consoles that are much easier to use and do not require a full-time person to monitor. Also, as the technology has been miniaturized, simplified and now uses a percutaneous access system, ECMOs are being used outside the OR, including the cath lab, when a large amount of support is needed that cannot be provided by IABPs or pVADs. 

 

Since the 1970s, intra-aortic balloon pumps (IABPs) have been the gold standard of minimally invasive hemodynamic support, but more recently developed percutaneous ventricular assist devices (pVAD) are offering an alternative. Clinical data shows pVADs offer more support than IABPs, but their much higher price tag currently restricts their use to niche applications, usually after an IABP fails to deliver enough support. 

Live demonstration, transmission or recording of transcatheter aortic valve replacement (TAVR) has been found feasible and safe, even for the typically high-risk patients who undergo the procedure. Results of the VERITAS late-breaking clinical trial, presented at the SCAI 2013 Scientific Sessions, confirmed via comparison of on- and off-camera case studies that recording procedures did not pose any additional risk or complications to patients. 

 

A new method of dynamic, personalized intravenous hydration significantly reduces the percentage of contrast-induced kidney injury from image-guided cardiovascular procedures, according to the results of the POSEIDON clinical trial presented as a late-breaking clinical trial at the SCAI 2013 Scientific Sessions.

For patients who received stents to restore blood flow through the main arteries supplying blood to the brain, inflating a tiny balloon inside the arteries after implantation of the stent  reduced restenosis, or repeat blockages, of the treated arteries, making them less likely to reclose. Modifying the order in which carotid stenting and balloon angioplasty is performed could also alter risk of stroke complications, according to the investigators of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) sub-study presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2013 Scientific Sessions. 

 

The impact of pediatric interventional cardiology has never been stronger, nor the need for organized, high-quality training greater, says Frank F. Ing, M.D., FSCAI, who delivered the annual Mullins Lecture at the Society for Cardiovascular Angiography and Interventions (SCAI) 2013 Scientific Sessions. He made the case that advances in technology and growth in the profession mean that now is the time to take training to the next level.

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