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VIDEO: Use of FFR-CT to Non-invasively Evaluate Coronary Lesion Severity

FFR Technologies | March 26, 2020

James Udelson, M.D., chief of the division of cardiology, Tufts Medical Center, explains how cardiac computed tomography (CT) scans are being used to create image-derived fractional flow reserve (FFR) values to determine if a coronary lesion is flow limiting. The FFR-CT can help determine if the patient needs a stent, or if the disease can be treated with medication. Tufts uses FFR-CT evaluations on non-emergency chest pain patients to reduce the need for diagnostic catheterizations. 

 

Related FFR-CT Content:

Image-based FFR May Replace Pressure Wires and Adenosine

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8 Cardiovascular Technologies to Watch in 2020

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FFR-CT is Ready for Prime-time Evaluation of Coronary Disease

6 Hot Topics in Interventional Cardiology at TCT 2019

FFR-CT: Is It Radiology or Cardiology?

 

Find more news and video from Tufts Medical Center

 

 

Cath Lab

FFR Technologies | March 26, 2020

James Udelson, M.D., chief of the division of cardiology, Tufts Medical Center, explains how cardiac computed tomography (CT) scans are being used to create image-derived fractional flow reserve (FFR) values to determine if a coronary lesion is flow limiting. The FFR-CT can help determine if the patient needs a stent, or if the disease can be treated with medication. Tufts uses FFR-CT evaluations on non-emergency chest pain patients to reduce the need for diagnostic catheterizations. 

 

Related FFR-CT Content:

Image-based FFR May Replace Pressure Wires and Adenosine

New Technology Directions in Fractional Flow Reserve (FFR)

8 Cardiovascular Technologies to Watch in 2020

VIDEO: Using FFR-CT in Everyday Practice

FFR-CT is Ready for Prime-time Evaluation of Coronary Disease

6 Hot Topics in Interventional Cardiology at TCT 2019

FFR-CT: Is It Radiology or Cardiology?

 

Find more news and video from Tufts Medical Center

 

 

Structural Heart Occluders | March 24, 2020

Interview with Carey Kimmelstiel, M.D., FACP, FACC, director, cardiac catheterization laboratory, director, interventional cardiology, Tufts Medical Center, discusses the patent foramen ovale (PFO) closure program at Tufts.  

Tufts was the lead enrollment site in the Gore and Amplatzer PFO closure device trials. The center works closely with both neurology to select patients who might benefits from PFO closure to help prevent cryptogenic stroke and or migraine headaches. Tufts uses structural heart transcatheter occuders in various anatomical positions and in the left atrial appendage (LAA).

 

Related PFO Closure Content:

VIDEO: How Transcatheter PFO Closure Can Reduce Cryptogenic Stroke — Interview with John Rhodes, M.D.

SCAI Offers Recommendations for Safe Use of PFO Closure Technologies

VIDEO: An Overview of PFO Closure to Treat Cryptogenic Stroke — Interview with Karen Orjuela, M.D.

VIDEO: Demonstration of a Transcatheter PFO Occluder Implantation

VIDEO: Addressing Adult Congenital Heart Referrals — Interview with Ami Bhatt, M.D.

VIDEO: Transcatheter Closure of Holes in the Heart — Interview with Ziyad Hijazi, M.D.
 

Find more videos and content on the Tufts Medical Center

 

Coronavirus (COVID-19) | March 20, 2020

An interview with Ehtisham Mahmud, M.D., FSCAI, chief, Division of Cardiovascular Medicine, executive director of medicine, Cardiovascular Institute, director of  interventional cardiology and cardiac cath lab at UC San Diego Medical Center, and president of the Society for Cardiovascular Angiography and Interventions (SCAI). He explains the how cardiology departments in the U.S. are now postponing cardiovascular procedures due to novel coronavirus (COVID-19, SARS-CoV-2) containment efforts and new guidelines from Medicare calling for delay of all elective procedures in the country. 

Mahmud explains how patients are being prioritized, with acute myocardial infarction patients or others with acute, life-threatening conditions, or at high risk for a near term hospital admission, will still receive cardiac catheterizations, cardiovascular surgery or structural heart procedures for MitraClip and transcatheter aortic replacement (TAVR) under certain circumstances. All other procedures are being postponed until further notice based in the spread and infection rates of COVID-19. He said most hospitals, including his own, are moving to telehealth visits via phone or online to continue clinic work with patients, including those with chronic conditions such as heart failure.

The Centers for Medicare and Medicaid Services (CMS) announced March 18, 2020, that all elective surgeries, and non-essential medical, surgical and dental procedures should be delayed during the coronavirus outbreak. This move is three-fold. 
   1. It is to help with containment efforts by reducing patient and family travel to hospitals, which are at the center of the COVID-19 outbreak. 
   2. Delaying procedures will help preserve and inventory of personal protective equipment (PPE), hospital beds and ventilators and other medical supplies. 
   3. With the start of social distancing and the shut down of all large gatherings, this has severely impacted blood drives and other blood donations, so the nation's blood banks have severely limited supplies.

“The reality is clear and the stakes are high — we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

This will not only preserve equipment but also free up the healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work toward limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. 
 

Related Cardiology Related COVID-19 Content:

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS)

CT Provides Best Diagnosis for Novel Coronavirus (COVID-19)

Radiology Lessons for Coronavirus From the SARS and MERS Epidemics

Deployment of Health IT in China’s Fight Against the COVID-19 Epidemic

Emerging Technologies Proving Value in Chinese Coronavirus Fight

Radiologists Describe Coronavirus CT Imaging Features

Coronavirus Update from the FDA

CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia

CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

Chest CT Findings of Patients Infected With Novel Coronavirus 2019-nCoV Pneumonia 

 

Additional COVID-19 Resources for Clinicians:

   ACC COVID-19 Hub page   

   Johns Hopkins Coronavirus Resource Center with inteavtive map of cases in U.S. and worldwide 

   World Health Organization (WHO) COVID-19 situation reports

   World Health Organization (WHO) coronavirus information page

   U.S. Food and Drug Administration (FDA) COVID-19 information page

   Centers for Disease Control (CDC) COVID-19 information page

   Centers for Medicare and Medicaid Services (CMS) frequently asked questions and answers (FAQs) for healthcare providers regarding COVID-19 related payments
 

 

Heart Failure | March 13, 2020

Interview with Navin Kapur, M.D., FAHA, FACC, FSCAI, executive director, The CardioVascular Center for Research and Innovation (CVCRI), and director of Cardiac Biology Research Center, Molecular Cardiology Research Institute (MCRI), Tufts Medical Center, Boston. He explains how temporary occlusion of the superior vena cava (SVC) appears to help reset the heart to normal function in heart failure patients. Kapur is currently involved in a trial using the PreCardia device pioneered at Tufts Medical Center.

Read more about the first late-breaking presentation of this technology at SCAI 2019 — Novel Therapeutic Approach Effective at Reducing Pressure for Heart Failure Patients
 

Find more videos and content on the Tufts Medical Center

Structural Heart | February 27, 2020

Charles D. Resor, M.D., MSc, assistant director, cardiac catheterization lab, Tufts Medical Center and assistant professor of medicine, Tufts University School of Medicine, explains the structural heart program at Tufts Medical Center. He outlines the centers' use of a variety of transcatheter interventional devices, including the MitraClip to repair mitral valve and tricuspid valve; occluders to seal congenital holes in the heart; PFO closure to prevent cryptogenic stroke; and the Watchman device to close the left atrial appendage (LAA) in atrial fibrillation patients.

 

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

 

Find more content on Tufts Medical Center

 

Tufts Medical Center | February 26, 2020

Lara Reyelt, veterinary technician and preclinical surgeon at the Interventional Research Laboratories (SIRL) at Tufts Medical Center, Boston, explains how research at her lab has helped advance human cardiovascular device technologies. 

Tufts Medical Center is unique in that it has a preclinical cath lab at the hospital, which allows for very close working relationships between the preclinical and the clinical teams, speeding up the collaboration and translational procedures. An example of this collaboration was the development of a new technique to treat congestive heart failure by temporarily occluding the SVC, which helps "reset" the heart. The lab also pioneered a novel approach now being used in the FDA DTU Trial to treat STEMI heart attacks with Impella hemodynamic support first, followed by 30 minutes of hemodynamic support prior to revascularizing the patient with percutaneous coronary intervention (PCI). The lab also performed preliminary work with the HeartMate PHP System to determine protocols for the now ongoing SHIELD II clinical trial. The lab also was used to test several new device technologies prior clinical trials, including the Impella 5.5 device. 

Find more videos and content on the Tufts Medical Center

 

Heart Valve Technology | February 18, 2020

Andrew Weintraub, M.D., FACC, associate director, of the Interventional Cardiology and Vascular Center, medical director of the Vascular and Structural Heart Center, Tufts Medical Center, discusses the use of temporary pacing in transcatheter aortic valve replacement (TAVR) patients. Implantation of TAVR valves can cause pressure from the valve against the septal wall of the heart, causing conduction delays. These delays do not necessarily mean the patient needs a permanent pacemaker.

Instead, Tufts Medical Center uses temporary pacing leads, a small catheter with two electrodes, placed in the right ventricle of the heart through a vein in the groin or neck. The lead is then connected to an external pacemaker allowing a physician to monitor and control a patient’s heart rate for up to several days.  The center uses the BioTrace Medical Tempo Lead, which incorporates a novel active fixation mechanism, bipolar electrodes and a soft tip. Stabilizers provide secure fixation and maintain stable pace capture. An elastomeric balloon may be inflated to aid passage of the lead through the venous vasculature and into the right ventricle, and  aids in wall apposition during deployment of the stabilizers. This design helps secure and stabilize the cardiac pacing lead with the goal of reducing complications and allowing patients to ambulate sooner after procedures.

 

Related Content:

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

VIDEO: Overview of the Structural Heart Program at Tufts Medical Center — Interview with Charles D. Resor, M.D.,

 

Find more content on Tufts Medical Center

 

 

 

Antiplatelet and Anticoagulation Therapies | February 18, 2020

Carey Kimmelstiel, M.D., FACP, FACC, director, interventional cardiology, director, cardiac catheterization lab, Tufts Medical Center, explains research on platelet inhibition agents used in the interventional lab. He discusses research and optimization of GP IIb IIIa inhibitors, changing protocols for tirofiban and the use of bivalirudin. 

Watch another interview with Kimmelstiel — VIDEO: Septal Ablation to Treat Hypertrophic Cardiomyopathy.
 

Find more content on Tufts Medical Center 

Heart Failure | February 10, 2020

Interview with James Udelson, M.D., chief of the division of cardiology at Tufts Medical Center, Boston. The hospital created a team of heart failure experts to work together to provide the best care options for patients to help improve outcomes.

The Tufts heart failure program offers various levels of hemodynamic support, up to left ventricular assist devices (LVAD) and heart transplants. The center is also using several cutting edge device technologies, including intra-atrial shunt device and controlling baroreceptors with a pacemaker type device. Tufts is also using devices in clinical trials, including a short term aortic pump to augment blood flow, and balloon occlusion of the superior venacava (SVC) to mitigate some heart failure symptoms. 

Find more content on Tufts Medical Center

Hemodynamic Support Devices | February 07, 2020

Interview with Navin Kapur, M.D., FAHA, FACC, FSCAI, executive director, The CardioVascular Center for Research and Innovation (CVCRI), director, Acute Mechanical Circulatory Support Program; director, interventional research laboratories; director of Cardiac Biology Research Center, Molecular Cardiology Research Institute (MCRI), Tufts Medical Center. He explains the Door-to-Unloading (DTU) Trial, which is using Impella hemodynamic support to unload the heart 30 minutes prior to percutaneous coronary intervention (PCI) in ST-elevated myocardial infarction (STEMI) patients. 

Data from a pilot trial and pre-clinical testing shows early hemodyanmic support prior to PCI helps reduce or eliminate the ischemia and limits myocardial damage due to ischemia. It also appears to help reduce the no-reflow phenomenon, reperfusion injury that  occurs in some heart attack patients who are revascularized, but the restoration of blood flow does not immediately help the patient. The DTU Trial is investigating if immediate hemodynamic support improves outcomes in STEMI patients. If it does, this could be a paradigm shift in therapy for these patients.

 

Related Door-to-unloading Content:

FDA Approves Initiation of STEMI DTU Pivotal Randomized Controlled Trial

VIDEO: The Door-to-Unloading (DTU) STEMI Safety and Feasibility Trial — Interview Nevin Kapur, M.D.

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock — Interview Nevin Kapur, M.D.

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use — Interview Nevin Kapur, M.D.

VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital — Interview with William O'Neill, M.D. 

Find more content on Tufts Medical Center 

 

Heart Valve Technology | January 28, 2020

Interview with Andrew Weintraub, M.D., FACC, associate director, of the Interventional Cardiology and Vascular Center, medical director of the Vascular and Structural Heart Center, Tufts Medical Center, and assistant professor of medicine, Tufts University School of Medicine. He explains the Tufts Medical Center transcatheter aortic valve replacement (TAVR) program.

Weintraub said TAVR usage has been increasing the past few years, and in 2019 the U.S. Food and Drug Administration (FDA) cleared the use of TAVR in all patient surgical risk categories, opening the procedure to all patients. He explained this will increase TAVR volumes in the coming years. 

Tufts Medical Center has been using the balloon-expandable Edwards Lifesciences Sapien valve for several years, but is plans to start using the self-expanding Medtronic Corevalve as well, because it may offer better outcomes in some types of patients. 

Learn how the pacemaker implant rate was reduced at Tufts Medical Center in the VIDEO: Use of a Temporary Pacing Lead in TAVR.

Watch the related VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

 

Find more content on Tufts Medical Center

 

Cath Lab | January 24, 2020

Interview with Carey Kimmelstiel, M.D., FACP, FACC, director, cardiac catheterization laboratory, director, interventional cardiology, Tufts Medical Center, and professor of medicine at Tufts University School of Medicine. He explains how septal ablation is used to treat hypertrophic cardiomyopathy (HCM). The Tufts Medical Center HCM program is the largest in New England. 

Tufts Medical Center performs septal ablation to treat medication-refractory HCM. They use a heart team approach to determine which patients are best served by surgical septal myectomy or alcohol septal ablation.

When drug treatments are ineffective, the center offers several procedures to treat HCM:
   
   • Implantable cardioverter defibrillators (ICDs)to prevent sudden cardiac death in high risk patients. 

   • Surgical septal myectomy for patients who experience significant limitation during physical activity and are unresponsive to medical drug treatment. This operation may be performed along with the Maze procedure to lessen the chances of recurrent atrial fibrillation.

   • Alcohol septal ablation for patients who are generally not ideal candidates for the myectomy operation. This procedure takes place in the catheterization laboratory without general anesthesia, and mimics the beneficial effects of surgery. 

   • Ablation for recurrent atrial fibrillation performed in the catheterization laboratory to lessen the likelihood for additional episodes.

   • Heart transplant for the some patients without obstruction who experience severe symptoms and are unresponsive to drug treatment.

 

Find more content on Tufts Medical Center 

 

 

 

Hemodynamic Support Devices | January 24, 2020

Navin Kapur, M.D., FAHA, FACC, FSCAI, director, Acute Mechanical Circulatory Support Program and executive director of The CardioVascular Center for Research and Innovation (CVCRI), Tufts Medical Center, explains how Tufts determines the level of hemodynamic support a patient needs. They use an algorithm to determine if low levels of support are needed with an intra-aortic balloon pump (IABP), or incrementally high levels with a percutaneous Impella pump, TandemHeart, extracorporeal membrane oxygenation (ECMO), or a surgically implanted ventricular assist device (VAD).


Watch the related VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital
 

Find more content on Tufts Medical Center 

Robotic Systems | January 20, 2020

This video shows the first robotic percutaneous coronary interventions (PCI) performed in Germany with the Robocath R-One robotic catheter guidance system. The first procedures were performed by Professor Michael Haude, director of Medical Clinic I at Rheinland Klinikum Neuss Lukaskrankenhaus, and his team. read more in the article First Robotic Coronary Angioplasties Performed With Robocath System in Germany.

 

Related Robocath Content:

Robocath Successfully Carries Out First Robotic Coronary Angioplasties in Humans

Robocath Receives $1.5 Million in Capital for Advancement of R-One Robotic System 

 

Cath Lab | January 09, 2020

Haval Chweich, M.D., medical director of the cardiac critical care unit (CCU) at Tufts Medical Center, and assistant professor at Tufts University School of Medicine, explains the role of intensivists on the cardiac care team. 

Chweich is an intensivist specialized in pulmonary and critical care. He interfaces with Tuft's cardiac surgeons and interventional cardiologists to care for patients as they transition after procedures into the CCU. He also plays a key role as part of the team caring for cardiogenic shock patients. 

Find VIDEOS and articles on Tufts cardiology program

Hemodynamic Support Devices | January 09, 2020

Richard Botto, CVT, RCSA, chief cardiovascular technologist, division of cardiology, cardiac cath lab, and Melissa Smith, RT, at Tufts Medical Center, Boston, explain the use of technology to remotely access data and waveforms on patients' temporary hemodynamic support system control consoles. 

Tufts Medical Center was one of the first hospitals to begin using the Abiomed Impella Connect technology, which enables remote smartphone access to Impella consoles. This allows a quick, remote check on patients using temporary hemodynamic support. The technology also is connected to a support center at Abiomed, so if a console or patient is experiencing issues out of the ordinary, techs can remote into the patient's Impella control console to take a look. Tuft's intensivists in the cardiac care unit (CCU) use the app to check on their patients' consoles without needing to walk into each room. 

Find VIDEOS and articles on Tufts cardiology program

 

Radiation Dose Management | December 19, 2019

 

Mahadevappa Mahesh, Ph.D., chief of medical physicist and professor of radiology and medical physics, Johns Hopkins University, Baltimore, treasurer of the American Association of Physicists in Medicine (AAPM),a board member of the American College of Radiology (ACR), presented a late-breaking study on how medical imaging radiation dose has started to drop over the past decade. He is the co-chair of the National Council on Radiation Protection and Measures Report (NCRP), and presented the most recent NCRP data analysis at the 2019 Radiological Society of North America (RSNA) meeting.

The new NCRP 184 report covers the period between 2006 and 2016, the period of the most current CMS data. It shows a decrease of about 20 percent in the radiation dose the U.S. population receives from medical imaging, compared to the NCRP 160 that covered the period of up to 2006.

Key findings of the study include:

   • CT dose dropped about 6 percent, despite a 20 percent increase CT scans since 2006;

   • Drop of more than 50 percent for nuclear imaging scans, mainly due to fewer procedures begin performed;

   • A 15-20 percent decrease across X-ray imaging modalities.

Mahesh says this shows the impact of using "as low as reasonably achievable" (ALARA) principals, new dose guidelines outlined jointly by numerous medical societies, and dose reduction initiatives like Image Wisely, Image Gently, and the American College of radiology (ACR) Dose Index Registry.

He said there was growing concern a decade ago when the last council report was published, which show a steep increase in radiation dose. This was mainly due to a rapid increase in the use of computed tomography (CT) and other types of X-ray based and nuclear radiotracer medical imaging. This prompted the ACR top create the Image Wisely program and push for the use of more thoughtful imaging doses based on patient size, using the "as low as reasonably achievable” (ALARA) principle. While CT dose was lowered, he said the biggest decline was in nuclear imaging.

 

 

RSNA | December 18, 2019

DAIC Editor Dave Fornell and Imaging Technology News (ITN) Consulting Editor Greg Freiherr offer a post-game report on the trends and technologies they saw on the expo floor of 2019 Radiological Society of North America (RSNA) annual meeting. This includes artificial intelligence (AI), augmented reality, holographic imaging, cybersecurity, and advances in digital radiography (DR) with a glassless detector plate, X-ray tomosynthesis, dual-energy X-ray and dynamic DR imaging. 

Find RSNA news and other videos

Radial Access | October 22, 2019

Sunil Rao, M.D., chief of cardiology, Durham VA Health System and a professor at Duke University, and Prashant Kaul, M.D., director of the cath lab, Piedmont, Atlanta, discuss trends in radial access at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting. They discuss how radial access adoption has grown rapidly in the past few years and now makes up between 40-50 percent of percutaneous coronary intervention (PCI) procedural volume in the United States. They also discuss recent clinical trial data and the new concept of using distal radial access. 

 

Related Radial Access Content:

SCAI Updates Expert Consensus Statement on Best Practices for Transradial Access

Transradial Access Celebrates 25 Years

VIDEO: History of Radial Artery Access — Interview with Ferdinand Kiemeneij, M.D.

Incorporating Distal Radial Artery Access Into Clinical Practice

VIDEO: New Frontiers in Radial Access — Interview with Mladen I. Vidovich, M.D.

Find more news and on transradial access technique and technology

Radial Access Adoption in the United States
 

 

Vascular Closure Devices | October 17, 2019

Ashish Pershad, M.D., chief of interventional cardiology, Banner University Medical Center, Phoenix, explains the trend of using closure devices to seal larger vascular access sites from the use of TAVR, EVAR, TMVR and hemodynamic support devices at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. He was one of the moderators on a session on this topic at TCT 2019.

 

Related Large Bore Vascular Closure Device Content:

VIDEO: How to Achieve Hemostasis With Large Bore Device Access — Interview with Philippe Genereux, M.D.

First-in-Human Results Show Early Bird Device Effective in Early Detection of Internal Bleeding

Advances and Trends in Vascular Closure Devices

Manta Large-Bore Vascular Closure Device Cleared by the FDA

PerQseal Large Bore Closure Device Launches in Europe

Teleflex Acquires Essential Medical

 

Related Content With Dr. Pershad:

National Coverage Determination Will Make TAVR Available to More Patients at More Centers

VIDEO: Comparison Between Watchman vs. Amulet LAA Occluders
 

Antiplatelet and Anticoagulation Therapies | October 17, 2019

Roxana Mehran, M.D., FACC, FACP, FCCP, FESC, FAHA, FSCAI, professor of medicine and director of interventional cardiovascular research and clinical trials at the Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine, explains the use of short dual antiplatelet therapy (DAPT) in minorities from the PLATINUM Diversity Trial. The first trial data was released in 2017, and she presented new data from the study at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. 

The study looked at use of the Promus Element Plus Post-Approval Study and the clinical impact of dual-antiplatelet therapy (DAPT) cessation within 12 months of drug-eluting stent implantation in caucasians and minorities. It is one of the first large trials to stress the importance of diversity in clinical trials, which tent to reflect a population of older white men.

 

Find more news and videos from TCT 2019

Hemodynamic Support Devices | October 16, 2019

Jeffrey J. Popma, M.D., director of interventional cardiology clinical services at Beth Israel Deaconess Medical Center, professor of medicine at Harvard Medical School, explains the results of the PROTECT II and the new PROTECT III Study at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. PROTECT III is the follow up to PROTECT II RCT and the largest-ever FDA study of hemodynamically supported, high-risk PCI patients. 

He discusses the PROTECT II and PROTECT III studies, and real-life patient data from the Impella IQ Database. 

 

Find more news and videos from TCT 2019

Structural Heart | October 16, 2019

Vivian Ng, M.D., assistant professor of medicine and an interventional cardiologist at the NewYork-Presbyterian/Columbia University Medical Center Structural Heart and Valve Center, helped organize the first Women in Structural Heart (WISH) event at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The evening session was standing room only and highlighted structural heart case presentations and discussion panels made up of all women. The session panelists and presenters were a whose-who of well known women in cardiology. The event was organized as a way to break the glass ceiling in the subspecialty of interventional cardiology, where women make up less than 5 percent of the operators.

 

Previous Video Interviews With Speakers and Panelists Involved in the WISH Session:

VIDEO: The Importance of the Neo-LVOT in Transcatheter Mitral Valve Replacement — Interview with Dee Dee Wang, M.D.

VIDEO: The Value of the Cardiovascular Service Line — Interview with Linda Gillam, M.D.,

VIDEO: Can We Live in 3-D Echo? — Interview with Lissa Sugeng, M.D.

VIDEO: Tricuspid Valve Imaging and Interventions Developing Hand-in-hand — Interview with Rebecca Hahn, M.D.

VIDEO: Strategies to Avoid Acute Kidney Injury Caused by Cath Lab Contrast — Interview with Roxana Mehran, M.D.,

 

 

Find more news and videos from TCT 2019

Antiplatelet and Anticoagulation Therapies | October 11, 2019

Ajay J. Kirtane, M.D., associate professor of medicine at Columbia University Irving Medical Center and director of the cardiac catheterization laboratories at NewYork-Presbyterian (NYP) Hospital, shares the findings of the late-breaking EVOLVE Short DAPT study presented as a late-breaking trial at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. It evaluated the safety of early dual antiplatelet therapy (DAPT) discontinuation in patients with high bleeding risk treated with the a Boston Scientific Synergy bioabsorbable polymer coated drug-eluting stent (DES).

With the advancement of new DES technologies using thinner struts and new types of drug-carrier polymer techniques, the risk of late-stent thrombosis has been greatly reduced, meaning there is less need for long-term DAPT. For patients who are at high risk for bleeding, who have ulcers or other types of gastrointestinal (GI) bleeding, or those going into surgery, it would be beneficial to reduce the time period for DAPT, and several late-breaking trials examined this at TCT 2019.
 

Here are the other late-breaking DAPT studies:

 

Find more news and videos from TCT 2019

Antiplatelet and Anticoagulation Therapies | October 10, 2019

Roxana Mehran, M.D., FACC, FACP, FCCP, FESC, FAHA, FSCAI, professor of medicine and director of interventional cardiovascular research and clinical trials at the Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine, explains insights from the Ticagrelor With Asprin or Alone in High-Risk patients after Coronary Intervention (TWILGHT) Trial. She presented this late-breaking study at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. Here is a link to the article on the TWILIGHT Trial.

 

Related Short DAPT Content:

VIDEO: Overview of Short DAPT in High-risk Bleeding Patients Who Receive Stents — Interview with AHA President Robert Harrington, M.D. at TCT 2019 

Onyx ONE: A Randomized Trial of a Durable-Polymer Drug-Eluting Stent vs a Polymer-Free Drug-Coated Stent in Patients at High Risk of Bleeding Treated With 1-Month DAPT - TCT 2019 late-breaker

IDEAL-LM: A Randomized Trial of a Bioabsorbable Polymer DES With 4-Month DAPT vs a Durable Polymer DES With 12-Month DAPT in Patients With Left Main Coronary Artery Disease - TCT 2019 late-breaker 

EVOLVE Short DAPT: A Single Arm Study of 3-Month DAPT in Patients at High Bleeding Risk Treated a Bioabsorbable Polymer-Based Everolimus-Eluting Stent - TCT 2019 late-breaker 

New Directions and Trends in Coronary Metallic Stents

Questions Remain on DAPT Prolongation

 

 

Find more TCT late-breaking news and video

Heart Valve Technology | October 09, 2019

Torsten Vahl, M.D., director of experimental and translational research, Structural Heart and Valve Center and at the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center, explains the current state of transcatheter arctic valve replacement (TAVR) following the U.S. Food and Drug Administration (FDA) clearance of TAVR in all surgical risk patient categories. Europe also cleared the use of the Sapien 3 device for low risk patients in November 2019.

He spoke on TAVR at the Transcatheter Cardiovascular Therapeutics (TCT) 2019 meeting. In August 2019, the FDA cleared the use of TAVR in all surgical risk classes of patients using the Edwards Sapien 3 and Medtronic CoreValve devices. This means the heart team made up of a cardiac surgeon, interventional cardiologist and cardiac imaging specialist can determine if surgical aortic valve replacement (SAVR) or TAVR should be used. It is widely expected TAVR use will rapidly rise in the next five years to take over 50 to 70 percent of the aortic valve replacement procedural volume. It is expected surgical volumes will drop to about 20 percent of patients who do not qualify for TAVR because of anatomic issues or other variables that make SAVR a safer option.

 

Related Transcatheter Valve Content:

FDA Approves TAVR for Low-risk Patients Creates A Paradigm Shift in Cardiology

Edwards Sapien 3 TAVI Granted European Approval to Treat Low-risk Patients

VIDEO: Tracking Transcatheter Valve Outcomes in the STS-ACC TVT Registry — John Carroll, M.D.

VIDEO: Transcatheter Mitral Valve Replacement Planning — Interview with Joao Cavalcante, M.D.

VIDEO: Overview of University of Colorado Structural Heart Program — Interview with John Carroll, M.D., Robert Quaife, M.D., and James Chen, Ph.D.

Advances in Transcatheter Tricuspid Valve Technologies

 

VIDEO: Update of Mitral Valve Repair and Replacement Technologies at TCT 2017 — Interview with Ted Feldman, M.D.,

TAVR Operator and Hospital Requirements Outlined in 2018 AATS/ACC/SCAI/STS Expert Consensus

VIDEO: Tricuspid Device Clinical Trial Overview — Interview with Ori Ben-Yehuda, M.D.

Recent Advances in Transcatheter Valve Technology

 

VIDEO: Tricuspid Valve Imaging and Interventions Developing Hand-in-hand at ASE 2018— Interview with Rebecca Hahn, M.D.

Hospital Consolidation May Increase Access to TAVR, New Cardiac Technologies

VIDEO: TAVR for Degenerated Surgical Valves - 2017 Update— Valve-in-Valve TAVR Procedures — Interview with Sammy Elmariah, M.D.

How to Perform Transcaval TAVR Access

 

VIDEO: The Essentials of CT Transcatheter Valve Imaging — Interview with Jonathon Leipsic, M.D.

Advances in Heart Valve Technology in 2017

VIDEO: TAVR For Asymptomatic Severe Aortic Stenosis — Interview with Philippe Genereux, M.D.

VIDEO: Conscious Sedation for TAVR Procedures — Interview with Mario Goessl, M.D.

 

VIDEO: Overview of the Henry Ford Hospital Structural Heart Program

Advances and Future Directions for Transcatheter Valves

Transcatheter Mitral Valve Replacement Devices in Development

 

 

 

 

Antiplatelet and Anticoagulation Therapies | October 08, 2019

American Heart Association President Robert Harrington, M.D., interventional cardiologist and the Arthur L. Bloomfield Professor of Medicine and chairman of the Department of Medicine at Stanford University, explains the reasons for shorter duration dual-antiplatelet therapy (DAPT) in high-risk bleeding patients. Newer-generation drug-eluting stents are designed for faster vessel healing and endothelialization, so the time required for DAPT can be reduced from 12 months to a shorter time period. At the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting there were several late-breaking trials that looked at shorter duration DAPT or use of mono-therapy with ticagrelor. 

Related Short DAPT Content:

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy vs Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing PCI - TCT 2019 late-breaker

Onyx ONE: A Randomized Trial of a Durable-Polymer Drug-Eluting Stent vs a Polymer-Free Drug-Coated Stent in Patients at High Risk of Bleeding Treated With 1-Month DAPT  - TCT 2019 late-breaker

IDEAL-LM: A Randomized Trial of a Bioabsorbable Polymer DES With 4-Month DAPT vs a Durable Polymer DES With 12-Month DAPT in Patients With Left Main Coronary Artery Disease - TCT 2019 late-breaker

EVOLVE Short DAPT: A Single Arm Study of 3-Month DAPT in Patients at High Bleeding Risk Treated a Bioabsorbable Polymer-Based Everolimus-Eluting Stent  - TCT 2019 late-breaker

 

Cardiogenic Shock | October 08, 2019

William O’Neill, M.D., medical director of the Center for Structural Heart Disease at Henry Ford Hospital, Detroit, explains data on first 250 patients in the National Cardiogenic Shock Initiative Study (NCSI) and new escalation protocols during the Transcatheter Cardiovascular Therapeutics (TCT) 2019 meeting. By implementing a protocol of using Impella hemodynamic support prior to percutaneous coronary intervention (PCI), the 80 centers involved in the initiative have been able to increase survival by 50 percent.

 

Related Cardiogenic Shock Content:

VIDEO: How to Reduce Cardiogenic Shock Mortality by 50 Percent — Interview with h Babar Basir, D.O.

SCAI Releases New Consensus Document on Classification Stages of Cardiogenic Shock

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock — Interview with Nevin Kapur, M.D.

10 Reasons Why it is Time to Learn More About Cardiogenic Shock — by Emmanouil S. Brilakis, M.D.

New Approaches to Reduce Cardiogenic Shock Mortality

VIDEO: Overview of the National Cardiogenic Shock Initiative — Interview with William O’Neill, M.D.

 

Find more TCT late-breaking news and video

 

 

TCT | October 04, 2019

Chandan Devireddy, M.D., offers insights about what he saw as the top take aways from the 2019 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting. He is cath lab director at Emory University Hospital Midtown, associate professor of medicine of interventional cardiology at Emory University, and chairperson for the Society of Cardiovascular Angiography and Interventions (SCAI) Communications Committee. 

Devireddy said his key take aways from TCT 2019 were:

   • The poor results of the Boston Scientific Acurate Neo self-explaining TAVR system compared to the current devices on the U.S. market;

   • Results of the Abbott Portico TAVR system;

   • Levant Trial shows no increased mortality due to use of a paclitaxel-coated balloon; and

   • CT study of TAVR valve leaflet thrombosis.

 

Find more TCT late-breaking news and video

 

University of Colorado Hospital | October 02, 2019

Interview with John Carroll, M.D., director of interventional cardiology, Robert Quaife, M.D., director of advanced cardiac imaging, and James Chen, Ph.D., associate professor of medicine and director of the 3-D imaging lab at the Cardiac and Vascular Center at the University of Colorado Hospital. They discuss how the structural heart program was created and how they invested in advanced imaging to grow into one of the most advanced programs in the country. They explain how the program now incorporates transcatheter aortic valve replacement (TAVR), transcatheter mitral valve repair, transcatheter mitral valve replacement (TMVR), left atrial appendage (LAA) occlusion and transcatheter closure of holes in the heart. 

The heart team in this video stressed the need for advanced imaging to plan and guide the procedures. They explain how the center developed its own 3-D imaging software and worked with Philips healthcare to commercialize some of the technologies, including the EchoNavigator system used to fuse live angiography with live transesophageal echo (TEE).

 

Related University of Colorado Hospital Content:

Highlighting Innovation at the University of Colorado Hospital Cardiology Program

VIDEO: Evolution of Transcatheter Mitral Valve Repair at the University of Colorado — Interview with John Carroll, M.D., and Robert Quaife, M.D.

VIDEO: The Role of Advanced Imaging in Structural Heart Interventions — Interview with Robert Quaife, M.D.

VIDEO: Advice For Hospitals Starting a Structural Heart Program — Interview with John Carroll, M.D.

VIDEO: The Evolution of Complex PCI at University of Colorado — Interview with John Messenger, M.D., and Kevin Rogers, M.D.

VIDEO: Developing New Cath Lab Technologies With Real-time Collaboration Between Industry, Doctors

360 View of the TEE Echo Workstation During a MitraClip Procedure

VIDEO: Walk Through of a Hybrid Cath Lab at the University of Colorado Hospital

VIDEO: Cath Lab Walk Through at the University of Colorado Hospital

VIDEO: The Cardiac Surgeon Perspective on Transcatheter Mitral Valve Repair — Interview with Joe Cleveland, M.D.

VIDEO: An Overview of PFO Closure to Treat Cryptogenic Stroke — Interview with Karen Orjuela, M.D.,

 

(This video was originally posted in May 2019 and was updated Oct. 2, 2019)

 

Heart Valve Technology | September 30, 2019

Marvin Eng, M.D., structural fellowship director at Henry Ford Health System, and William O'Neill, M.D., director of the Henry Ford Hospital structural heart program, explain the mitral valve repair program at Henry Ford. 

The hospital performs a large number of transcatheter mitral valve repairs, including MitraClip and with its involvement in trials for investigational device technologies. 

Watch the VIDEO: Overview of the Henry Ford Hospital Structural Heart Program

Find more news and video from Henry Ford Hospital

(Editor's note - this article was originally published in March 2019 and was revised Sept. 30, 2019)

 

 

 

Structural Heart | September 30, 2019

A discussion with William O’Neill, M.D., director of the Henry Ford structural heart program, Ruth Fisher, MBA, vice president of the program, and Janet Wyman, NP, program manager. Henry Ford Hospital has built a large, high-volume structural heart program that includes use of cutting edge new technologies and devices. 

Watch the related VIDEO: How to Get Referral Patients Into a Structural Heart Program — Henry Ford Hospital shares insights from its program.
 

Additional articles and videos on Henry Ford Hospital 
 

(Editor's note - this video was originally published in September 2018 and was revised September 2019)

Cardiovascular Business | September 30, 2019

A discussion with Ruth Fisher, MBA, vice president of the Henry Ford Hospital structural heart program, and Janet Wyman, NP, program manager. They explain how Henry Ford has been able to build its program and work with hospitals throughout Michigan, including those with their own transcatheter aortic valve replacement (TAVR) programs. They said building relationships with referral centers as partners and ensuring the patients go back to their local physicians for followups and regular care is key. 

Watch the related VIDEO: Overview of the Henry Ford Hospital Structural Heart Program.

(Editor's note - this article was originally published in April 2019 and was revised Oct. 1, 2019)

Additional articles and videos on Henry Ford Hospital 

 

 

 

Chronic Total Occlusion (CTO) | September 28, 2019

A discussion with Khaldoon Alaswad, M.D., director, cardiac catheterization lab, Henry Ford Hospital, on treating chronic total occlusions (CTOs) and other complex PCI cases. Watch the VIDEO: Treating Chronic Total Occlusions with Bill Lombardi, M.D., director of complex coronary artery interventions at the University of Washington. Read the article "How to Tackle Coronary CTOs."

Additional articles and videos on Henry Ford Hospital 

 

Related Chronic Total Occlusion Content: 

VIDEO: New Technology to Treat Chronic Total Occlusions (CTOs), an interview with Farouc Jaffer, M.D., Ph.D.

When to Consider Revascularization of Coronary Chronic Total Occlusions

VIDEO: Treating Chronic Total Occlusions, an interview with Bill Lombardi, M.D.

VIDEO: The Evolution of Complex PCI at University of Colorado  — Interview with John Messenger, M.D., and Kevin Rogers, M.D.

How to Tackle Coronary CTOs

 

(Editor's note - this video was originally published in September 2018 and was revised September 2019)

Cath Lab | September 28, 2019

A discussion with Nicolas Bevins, Ph.D., vice chair, physics and research, and Jessica Harrington, RCIS. They explain the use of shields, technique and use of newer angiography technologies to reduce X-ray radiation dose in the cardiac cath labs at Henry Ford Hospital, Detroit.

Watch the VIDEO: Technologies and Techniques to Reduce Radiation Dose in the Cardiac Cath Lab — Interview with Akshay Khandelwal, M.D., director of medical operations at the Henry Ford Heart and Vascular Institute

Additional articles and videos on Henry Ford Hospital 

 

For more on how to reduce dose in the cath lan, read these related articles:

Cardiology Societies Call for Better Radiation Dose Tracking

Defining the Cath Lab Workplace Radiation Safety Hazard

Dose-Lowering Practices for Cath Lab Angiography

5 Technologies to Reduce Cath Lab Radiation Exposure

VIDEO: Heart Surgeon Shares Effects of Fluoroscopic Radiation Exposure

Helping Interventional Cardiologists Reduce Exposure to Ionizing Radiation

14 Ways to Reduce Radiation Exposure in the Cath Lab

 

(Editor's note - this video was originally published in September 2018 and was revised September 2019)

September 27, 2019

Akshay Khandelwal, M.D., director of medical operations at the Henry Ford Heart and Vascular Institute, Detroit, and associate professor of cardiology at Wayne State University, explains how his center has reduced X-ray radiation dose in the cardiac catheterization labs.

Watch the related VIDEO: Reducing Cath Lab Radiation Dose at Henry Ford Hospital — Discussion with Nicolas Bevins, Ph.D., vice chair, physics and research, and Jessica Harrington, RCIS, Henry Ford Hospital.

Additional articles and videos on Henry Ford Hospital 

 

For more on how to reduce dose in the cath lan, read these related articles:

Cardiology Societies Call for Better Radiation Dose Tracking

Defining the Cath Lab Workplace Radiation Safety Hazard

Dose-Lowering Practices for Cath Lab Angiography

5 Technologies to Reduce Cath Lab Radiation Exposure

VIDEO: Heart Surgeon Shares Effects of Fluoroscopic Radiation Exposure

Helping Interventional Cardiologists Reduce Exposure to Ionizing Radiation

14 Ways to Reduce Radiation Exposure in the Cath Lab

 

(Editor's note - this video was originally published in November 2018 and was revised September 2019)

 

Hemodynamic Support Devices | September 22, 2019

There was a 77 percent increase in survival in cardiogenic shock patients treated using a new protocol in the National Cardiogenic Shock Initiative. The data was presented at the 2018 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The details are discussed here with Babar Basir, D.O., and William O'Neill, M.D., from Henry Ford Hospital

Watch the related VIDEO: Overview of the National Cardiogenic Shock Initiative

Watch the related VIDEO: Support Protocols at Henry Ford Hospital

Additional articles and videos on Henry Ford Hospital 

(Editor's note - this video was originally published in September 2018 and was revised September 2019)

Hemodynamic Support Devices | September 12, 2019

A discussion with William O'Neill, M.D., director of the structural heart program, Henry Ford Hospital, and Michele Voeltz, M.D., fellowship program director, interventional cardiology, explaining their process for selecting various levels of hemodynamic support.

Henry Ford Hospital also helped spearhead the Detroit Cardiogenic Shock Initiative that morphed into the National Cardiogenic Shock Initiative using these same protocols. Watch an interview with O'Neill explaining the national initiative.

Additional articles and videos on Henry Ford Hospital 

(Editor's note - this video was originally published in September 2018 and was revised September 2019)

 

 

Chronic Total Occlusion (CTO) | August 23, 2019

Interview with Kevin Rogers, M.D., director of vascular medicine at the University of Colorado Hospital. He explains what wires he uses for chronic total occlusions (CTOs). The university of Colorado is a high-volume CTO center. Read more about the Innovation at the University of Colorado Hospital Cardiology Program.

 

Related Chronic Total Occlusion Content: 

VIDEO: How to Treat CTOs and Complex PCI Cases — Interview with Khaldoon Alaswad, M.D.

Recent Advances in Interventional Guidewire Technology

VIDEO: New Technology to Treat Chronic Total Occlusions (CTOs), an interview with Farouc Jaffer, M.D., Ph.D.

When to Consider Revascularization of Coronary Chronic Total Occlusions

VIDEO: Treating Chronic Total Occlusions, an interview with Bill Lombardi, M.D.

VIDEO: The Evolution of Complex PCI at University of Colorado  — Interview with John Messenger, M.D., and Kevin Rogers, M.D.

How to Tackle Coronary CTOs

Heart Failure | June 28, 2019

Federico Asch, M.D., FASE, director of cardiac imaging research and director of the cardiovascular imaging lab, MedStar Health Research Institute, Washington, D.C., explains the importance of the COAPT Trial and the cardiac ultrasound findings from the study. It was presented as a late-breaking study at the American College of Cardiology (ACC) 2019 meeting and the sub-study was discussed in several sessions at the 2019 American Society of Echocardiography (ASE) conference.

The trial showed the Abbott MitraClip can be used to help large numbers of patients with heart failure who experience increasing levels of mitral valve regurgitation due to the enlargement of their hearts. 

Read more about the COAPT Trial

VIDEO: MitraClip to Treat Heart Failure - Results of the COAPT Trial — Interview with William Abraham M.D. 

VIDEO: Impact of the COAPT Trial on Heart Failure Patients With Functional Mitral Regurgitation — Interview with Andreas Brieke, M.D.

FDA Approves MitraClip for Use in Heart Failure Patients With Functional Mitral Regurgitation

360 View of the TEE Echo Workstation During a MitraClip Procedure

 

 

 

 

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