The late-breaking MitraBridge Study was presented at Transcatheter Cardiovascular Therapeutics (TCT) 2020 meeting showed the transcatheter MitraClip mitral leaflet repair system can be used as bridge therapy to heart transplantation. About 25 percent of patients in this study were actually taken off the transplant list because they became asymptomatic. This is the press conference for the study presented by Cosmo Godino, M.D., an interventional cardiologist from San Raffaele Hospital, Milan, Italy. It is followed by a discussion by several well-known interventional cardiologists and structural heart experts.

Find additional TCT 2020 news, video and late-breaking studies

Jordan G. Safirstein, M.D., FACC, FSCAI, director of transradial catheterization for Atlantic Health System’s Morristown Medical Center, Morristown, N.J., explains the new radial access lounge at the Gagnon Cardiovascular Institute.

Transradial access lounges are specifically designed to meet the needs of cardiac catheterization patients who have had their procedure performed through a catheter inserted into their radial artery in the wrist, also known as transradial catheterization. This procedure, which has a shorter recovery period and less bleeding risk than traditional cardiac catheterizations done through the femoral (groin) artery, is now an option for many patients who are catheterized in order to conduct a diagnostic angiogram or have an angioplasty or stent procedure. 

Patients can walk around, use the washroom, get coffee and sit in lounge chairs for their recovery while being monitored via wireless telemetry. This is a stark contrast to the transfemoral artery access recovery, which requires six hours of bed rest and can be very uncomfortable for the patient.

“Nearly half of all cardiac catheterizations are now done transradially, and there is plenty of data to show it is very safe and can be done as an outpatient procedure” Safirstein explained. “We saw the need for a recovery area for these patients that was more comfortable.  These patients don’t need a traditional recovery room. Our goal is to safely send patients home on the same day of their procedure but while they spend time with us, it should be time spent relaxing, reading, receiving education about their procedure and prevention of future events. If they need new medications, we can provide that to them before they leave.”

Read more about the lounge in the article Atlantic Health Morristown Medical Center Opens Radial Lounge for Post-procedure Recovery.

Related Transradial Access Content:

VIDEO: Tour of a Radial Access Recovery Lounge That Mimics Cafe Atmosphere — Interview with Jack P. Chen, M.D.

VIDEO: The Benefits of Transradial Access — Interview with Jack P. Chen, M.D.

Radial Access Recovery Lounge Mimics Cafe Atmosphere

VIDEO: History of Radial Artery Access - an interview with Ferdinand Kiemeneij, M.D.

VIDEO: Radial Access Lounge Walk Through at Morristown Medical Center

Radial Access, Same-Day Cardiac Procedure Could Save $300 Million Annually

VIDEO: Update on U.S. Transradial Access Adoption — an interview with Sunil Rao, M.D.

VIDEO: Trends in Radial Access for Percutaneous Coronary Interventions — Interview with Sunil Rao, M.D., and Prashant Kaul, M.D.

Transradial Access Celebrates 25 Years

Find more radial access news and video

Nick West, M.D., chief medical officer for Abbott, explains the details from a survey of 1,400 patients, physicians and healthcare executives in an effort to understand the needs to guide future technology development. Artificial intelligence (AI) is being looked at as a way to better personalize medicine. In the cath lab, AI might be used to help interpret intravascular images as a second set of eyes for the physician. AI also might enable immediate feedback on how to proceed with a case based on current guidelines and clinical evidence.

Read more about the survey in the article "Emerging Technology and Data Key to Closing Treatment Gaps to Improve Cardiovascular Care."

See Part 1 of this video where west describes the key findings of the survey in the VIDEO: Survey Shows Large Disconnect in Medical Technology Across Continuum of Care.

Nick West, M.D., chief medical officer for Abbott, explains the details from a survey of 1,400 patients, physicians and healthcare executives in an effort to understand the high-level issues regarding the use of technology in medicine, the gaps in communication, and patient perceptions to guide future technology development. 

Four high-level observations emerged from our study:

1. Patients are frustrated by the level of care they’re receiving – they understandably want a personalized healthcare experience “tailored for me,” across the care continuum.

2. Physicians lament the lack of time they have to spend with patients, their limited visibility into patient adherence to treatment and lifestyle changes, and challenges with other key factors that influence the quality of care they can provide.

3. Administrators are pressured to deliver patient satisfaction and reduce costs across multiple departments.

4. Diagnostic and data-driven technology holds the promise to move care from a point-in-time, intervention-only focus to a more holistic “whole patient” view by improving the accuracy of
diagnosis, appropriate interventions as required, and evidence-based post-procedural care.

Read more about the survey in the article "Emerging Technology and Data Key to Closing Treatment Gaps to Improve Cardiovascular Care."

See Part 2 of this video where West describes the how AI might be used in interventional cardiology in the VIDEO: Artificial Intelligence May Improve Cath Lab Interventions.

Juan F. Granada, M.D., CEO of the Cardiovascular Research Foundation (CRF) worked on preclinical development work for a couple drug-eluting balloons (DEBs) and offers an overview on the technology. 

Granada also sheds some light on the biggest question regarding drug-coated balloons (DCBs) with the 2019 U.S. Food and Drug Administration warning that the devices might cause higher mortality, based on a December 2018 meta-analysis of trial data that showed an increased mortality signal. This was a big topic of discussion at TCT 2019 and again at SCAI in 2020 and more recent study data has shown there is no safety issue. 

The basic DCB technology is also discussed by Granada, who explains how the excipients used to carry to anti-proliferative drug on the balloon surface and the crystalline structure of the drug are key differentiators. He said these two elements are key in how much drug is delivered and the duration of its elution in the vessel wall.
 

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VIDEO: SCAI Prospective on Key Takeaways at TCT 2019 — Interview with Chandan Devireddy, M.D., including discussion of the LEVANT study results

With COVID-19 forcing all medical conferences to go virtual in 2020, Juan F. Granada, M.D., CEO of the Cardiovascular Research Foundation (CRF) explains how this year's Transcatheter Cardiovascular Therapeutics (TCT) 2020 meeting is being structured and some of the advantages of the virtual format. He also shares how the virtual format was actually very helpful at CRF's Transcatheter Valve Therapeutics (TVT) Structural Heart Summit earlier this summer.

Virtual cardiology meetings so far in 2020 have found the format enables much more participation by international physicians than in the past. TCT is using this idea to focus sessions aimed at Asia and Europe at different parts that correspond to the end of the work day in those parts of the world. Granada said U.S. focused sessions will take place toward the end of the day across the United States to accommodate more attendees during the sessions, since many will be attending after they are finished for the day, rather than take days off to attend.

Virtual Cardiology Meetings During COVID-19 Allowing More International Attendance

VIDEO: Insights Into How HRS Organized its Virtual Meeting — a discussion with Krahn after the HRS 2020 virtual meeting on lessons learned.

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 the research being done by the Cardiogenic Shock Working Group, which is headed by Tufts. 

The Cardiogenic Shock Working Group (CSWG) has created a patient registry now includes 15-20 centers in the United States and data on more than 2,000 patients who suffered shock either from heart failure or acute myocardial infarction (MI). It also includes hemodynamic data on more than 1,100 patients. It also includes all types of mechanical circulatory support devices, from intra-aortic balloon pump (IABP),  incrementally higher levels with a percutaneous Impella pump, TandemHeart, and extracorporeal membrane oxygenation (ECMO).

Research last year showed three types of phenotype profiles in cardiogenic shock patients, including non-congested, cardio-renal and cardio-renal-hepatic. Kapur also said there is evidence that there is venous involvement that needs to be considered in future research.

The large amount of variables in the patient data from the CSWG is partly examined by artificial intelligence (AI), which helped identify the three shock phenotype profiles.

Related Cardiogenic Shock and Hemodyanmic Support Content:

VIDEO: Door-to-Unloading (DTU) Trial May Change STEMI Care

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use

VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital

VIDEO: Cardiogenic Shock Initiative Continues to Reduce Mortality by 50 Percent

VIDEO: How to Reduce Cardiogenic Shock Mortality by 50 Percent

SCAI Releases New Consensus Document on Classification Stages of Cardiogenic Shock

Cardiogenic Shock Survival Rates Improve in Three Years Since Impella FDA Approval

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock

VIDEO: Escalation of Support and Algorithms for Cardiogenic Shock

10 Reasons Why it is Time to Learn More About Cardiogenic Shock

New Approaches to Reduce Cardiogenic Shock Mortality

Find more content on Tufts Medical Center 

The Vieussens’ arterial ring (VAR) is a connection between the conus artery and the left anterior descending (LAD) coronary artery’s proximal right ventricular branch. VAR is present in about 48 percent of the population as an embryonic conotruncal ring remnant. This ring can be exploited as an alternative coronary artery revascularization route in patients where this anatomy is present. Guidewires can be navigated from the right coronary artery through the conus to the LAD.

Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital, Royal Oak, Michigan, created this video to briefly explain the use of the Vieussens’ arterial ring in interventional cardiology.  

Mohan is board certified in cardiology, internal medicine, echocardiography and nuclear cardiology. He also serves as vice president of the Dr. Ramesh Kumar Foundation. 

Mohan shares regular updates on Twitter about recent cardiology technology devices, takeaway points from conferences and short educational videos he produces. Follow or contact him via Twitter or Instagram at @cardiologyoncall.

Related Cardiovascular Educational Videos Created by Jay Mohan, D.O.:

VIDEO: The Latest Data on COVID-19 and Cardiovascular Disease

VIDEO: Creating a Home COVID-19 Decontamination Area for the Clinician

Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital, Royal Oak, Michigan, created this video. It shows other clinicians how he set up his home COVID-19 decontamination area where he changes clothes, shoes and sterilizes before entering his house in order to protect his family. He has been involved with direct care of COVID-19 patients the past two months.

Since the start of the SAR-CoV-2 pandemic, clinicians and first-responders who are in contact with, or possible contact with, COVID-19 patients have developed ways to not bring and viral contamination home with them. This often includes on transition spot in the garage or designed room where they can change out of work clothing and shoes and into new clothing and shoes. Shoes and coats are separated into ones used for home and those dedicated for use at work only. Those who wear and reuse N95 masks also have developed ways to take the mask off by the straps only so they do not touch it and strapping it over a tupperware container that can then be sealed, or stored inside a disposable paper or plastic bag.

Mohan is board certified in cardiology, internal medicine, echocardiography and nuclear cardiology. He also serves as vice president of the Dr. Ramesh Kumar Foundation. 

Mohan shares regular updates on Twitter about recent cardiology technology devices, takeaway points from conferences and short educational videos he produces. Follow or contact him via Twitter or Instagram at @cardiologyoncall.

Watch a video animation he created — VIDEO: The Latest Data on COVID-19 and Cardiovascular Disease.
 

Find more cardiovascular related COVID-19 content

Thomas Maddox, M.D., MSc, FACC, the chair of the American College of Cardiology (ACC) Science and Quality Committee, explains concerns by ACC in a large drop in ST-elevation myocardial infarction (STEMI) heart attacks and strokes since the U.S. spread of COVID-19. Maddox is also the executive director of the Healthcare Innovation Lab of BJC Healthcare and Washington University School of Medicine, St. Louis. He is also an assistant professor of cardiology at Washington University.

The ACC is concerned about the 35-40 percent drop in STEMI and stroke patients presenting to emergency rooms across the U.S. and internationally since the start of the novel coronavirus (COVID-19, SARS-CoV-2) pandemic. Maddox is alarmed by the drop in cases and suspects patients are deciding to stay home rather than go to the hospitals out of fear about catching COVID-19. ACC launched a public relations campaign April 14, 2020, aimed at the public to get them to call 911 or go to hospitals if they have symptoms of stoke of a heart attack. Maddox said hospitals are still seeing and treating non-COVID-19 patients and the cardiovascular departments are still activating their cath labs to handle and acute cardiac cases that come in. 

He said Spain, which was hit earlier than the U.S. by the virus, saw a STEMI case decrease of about 40 percent. Based on limited U.S. data, he said U.S. cath lab activations are down about 35 percent. A clearer picture of the actual numbers of STEMI and other PCI cases will not be known from the ACC National Cardiovascular Data Registry (NCDR) until later this year, since most hospitals pull this data quarterly.

ACC is offering resources for the public  at www.cardiosmart.org/Coronavirus to evaluate their symptoms and help decide it they should go to the hospital or call 911.

Read the related article "Rapid Drop in Heart Attacks and Stroke at Hospitals Concerns ACC."

Watch another interview with Maddox in the VIDEO: What Cardiologists Need to Know about COVID-19.

DAIC Editor Dave Fornell has conducted numerous video interviews remotely from his home office in March and April 2020 with nine cardiologists from around the United States. After each interview he asked how COVID-19 has impacted their hospital and them personally. This video offers a candid overview of their thoughts in the fight against the novel coronavirus.

Each was interviewed for other videos and some of the comments used here were from a questions after the main interview on how novel coronavirus (COVID-19, SARS-CoV-2) is impacting them, their patients or their cardiology departments. 

Insights include the following doctors. Click on the names to see their videos from March and April 2020:

   • Thomas Maddox, M.D., Washington University School of Medicine, St. Louis
   • Ehtisham Mahmud, M.D., UC San Diego Medical Center
   • William O’Neill, M.D., Henry Ford Hospital, Detroit
   • Regina Druz, M.D., Integrative Cardiology Center of Long Island, N.Y.
   • Justin Fried, M.D., Columbia University Irving Medical Center, New York City
   • Hicham Skali, M.D., Brigham and Women’s Hospital, Boston
   • Stephen Bloom, M.D., FASNC, Midwest Heart and Vascular Associates, Overland Park, Kansas
   • Michael Mack, M.D., Baylor Scott and White, Dallas, Texas
   • Basel Ramlawi, M.D, Heart and Vascular Center at Valley Health System in Virginia

Find more videos and news on the impact of COVID-19 on cardiology

Detroit, Michigan, has been one the hardest hit regions with a large number of COVID-19 cases. William O’Neill, M.D., medical director of the Center for Structural Heart Disease at Henry Ford Hospital, explains the impact of novel coronavirus (COVID-19, SARS-CoV-2) on the cardiology program and his takeaways on COVID-19 cardiovascular involvement based on cases he has seen.

O'Neill said ST-elevated myocardial infarction (STEMI) cases have mysteriously dropped off significantly since quarantines began, a reflection of a nationwide trend. He also said he has not seen a lot of myocarditis or cardiogenic shock COVID-19 patients, except for a small handful. These conditions have been reported elsewhere in COVID-19 patients, but O'Neill said the patients he has seen die of COVID-19 usually have an onset of a cytokine storm, lose vascular integrity and then all their organs fail. He has not seen a primary cardiac component involved in most of the critically ill patients where hemodynamic support would have helped. 

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The Cardiac Implications of Novel Coronavirus

A review of the PARTNER 3 Low-Risk Trial with Michael Mack, M.D., chairman, cardiovascular service line,  Baylor Scott and White Health, Dallas Texas, chairman of the board of the BSW Health Research institute, Dallas, and co-principal investigator of the trial. The PARTNER 3 Low-Risk Trial two-year data were presented as a late-breaking study at the virtual American College of Cardiology (ACC) 2020 annual meeting. The trial offers additional evidence that TAVR performs as well as surgery in select low-risk patients. 

Mack said the trial included patients over the age of 65, and there is still a question about long-term durability of the Sapien 3 TAVR valve used in trial before it is used in younger patients. He said patients in this trial will be tracked out to 10 years, which will offer a lot of information on durability of the current iteration of this valve. In the video, he also elaborates on TAVR issues involved with bicuspid aortic valves and other patient selection issues.

PARTNER 3 enrolled 1,000 patients with severe aortic stenosis and a Society of Thoracic Surgeons (STS) risk score of less than 4 percent. All patients had a tricuspid aortic valve. Half of the participants were randomly assigned to undergo TAVR and half underwent surgery. At two years, 11.5 percent of patients receiving TAVR and 17.4 percent of those receiving surgery died, suffered a stroke or were rehospitalized for cardiovascular problems, a difference in the composite primary endpoint that researchers reported as showing non-inferiority, meaning neither treatment was superior to the other.

In a secondary analysis, rates of death and stroke were found to be not significantly different between the two groups. Death occurred in 2.4 percent of those receiving TAVR and 3.2 percent of those receiving surgery, while stroke occurred in 2.4 percent of those receiving TAVR and 3.6 percent of those receiving surgery. Rehospitalization rates showed a significant difference in favor of TAVR; 8.5 percent of those receiving TAVR and 12.5 percent of those receiving surgery were rehospitalized for cardiovascular reasons during the study period. 

Read more details about this trial 

Read the one year trial results from ACC 2019

Find other ACC news and videos
 

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 very closely with neurology to select patients who might benefits from PFO closure to help prevent cryptogenic stroke and or migraine headaches. Tufts uses structural heart transcatheter occluders 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

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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

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

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

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 

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 showed early hemodynamic 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 

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 

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.

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