Herbert Aronow, M.D., MPH, St. Joseph Mercy Hospital, Ann Arbor, and an active member of ACC and SCAI, explains the top interventional cardiology highlights at TCT 2013.
VIDEO: Technologies and Techniques to Reduce Radiation Dose in the Cardiac Cath Lab
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.
For more on how to reduce dose in the cath lan, read these related articles:
This animation, provided by Abbott, demonstrates how the FDA-cleared MitraClip transcatherer mitral valve repair system in implanted in the heart. The device requires a transeptal puncture and real-time guidance under angiography and 3-D transesophageal echo (TEE).
Related Transcatheter Mitral Valve Technology Content:
VIDEO: Update of Mitral Valve Repair and Replacement Technologies - Interview with Ted Feldman, M.D.
VIDEO: Transcatheter Mitral Valve Implantation in Practice and Technologies in Development - Interview with Adam Greenbaum, M.D.
VIDEO: Overview of Transcatheter Mitral Valve Repair Technologies — Interview with Ted Feldman, M.D.
VIDEO: Transcatheter Mitral Valve Technology, Anatomical Challenges — Interview with Juan Granada, M.D.
Ajay Kirtane, M.D., SD, chief academic officer at Columbia University Medical Center/New York Presbyterian Hospital, explains the key highlights regarding interventional cardiology at the American College of Cardiology (ACC) 2013. These included data on the use of cangrelor vs. clopidogrel during cath lab procedures, first U.S. reports on using the smaller Sapient XT transcatheter aortic valve, and the safety of using shorter duration dual-antiplatelet therapy with drug-eluting stents.
The American College of Cardiology (ACC) 2013 Scientific Session Committee Chairman Miguel Quinones, M.D., explains some of the key highlights from this year's meeting. Highlights included the impact of niacin on lowering cholesterol, new data on transcatheter aortic valve repair, and how mummies show atherosclerosis is not a modern disease.
DAIC Editor Dave Fornell explains his choices for the most innovative new technology on the expo floor at the American College of Cardiology (ACC) 2013. These include new angiography systems, dose monitoring software and technology integrations, an iPhone ECG monitoring device, ultrasound-aided CRT lead optimization, and new radiation protection aprons that are up to 50 percent lighter.
This short cine loop shows a 3-D/4-D transesophegeal echo (TEE) view of a transcatheter Amplatzer closure device used to seal an atrial septal defect (ASD) and the operation of a surgically implanted St. Jude Medical mechanical mitral valve. This type of complex ASD transcatheter repair is much easier to perform under real-time 3-D TEE guidance. This image was provided by GE Healthcare's Vivid E9 Breakthrough 2012 (BT12), which includes a 4-D transducer for TEE.
DAIC Editor Dave Fornell highlights the latest advancements that will impact cardiovascular imaging from the 2012 Radiological Society of North America (RSNA) meeting. RSNA is the largest medical imaging show in the world and most advancements are shown here first.
One-year results from the ADAPT-DES Trial were presented during TCT 2012. It examined patient hyporesponsiveness to clopidogrel and aspirin in a large-scale, prospective, multicenter study.
Mercy Hospital in Chicago developed an interventional program around its hybrid cath labs, fostering collaboration between interventional cardiologists, vascular surgeons and interventional radiologists. This collaboration has helped the hospital improve care and keep costs low in order to serve the Chicago South Side's low-income population. Read the article "Most Innovative Heart Centers: Chicago’s Mercy Hospital." There is also a related VIDEO about Mercy, "Developing a Hybrid Cath Lab Program."
Mercy Hospital in Chicago has developed a successful hybrid cath lab program where various specialties work together for the best, minimally invasive patient outcomes. Beyond the coronaries, this cath lab specializes in endovascular aortic stent grafting, peripheral vascular disease, embolization procedures and transcatheter heart valve replacements. Read the related article "Most Innovative Heart Centers: Chicago’s Mercy Hospital." Watch the related Mercy VIDEO "Mercy Hospital Develops Effective, Collaborative Interventional Program."
Results from the POSEIDON Trial were presented at TCT 2012. Data showed a positive strategy to prevent contrast-induced nephropathy in patients with renal impairment undergoing interventional catheterization procedures.
The PC Trial data presented at TCT 2012 looked at transcather PFO closure vs. medical therapy in preventing cryptogenic strokes.
The results of the FAME II Trial were presented at the 2012 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The study showed the cost effectveness of fractional-flow reserve (FFR) therapy vs. standard medical therapy.
Positive results from the RESPECT trial of transcatheter PFO vs. standard medical therapy were presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2012 meeting.
This video, provided by Crux Biomedical, demonstrates the implantation of the FDA-cleared Crux VCF inferior vena cava filter (VCF) with bi-directional retrieval. It is designed to trap blood clots that can lead to potentially fatal pulmonary embolisms among patients at risk. The Crux VCF is the first designed to facilitate bi-directional retrieval through either the femoral or jugular veins, a key consideration when access to one or the other vein is limited. The helical shape was designed to self-center and to conform more closely to the shape of the vena cava, as well as to reduce bends and stress that can compromise filter integrity. Read the article "Large-Scale Inferior Vena Cava Filters Study Examines Safety and Effectiveness of These Devices."
Three big trends were seen in cardiovascular ultrasound during the American Society of Echocardiography (ASE) 2012 meeting. Malissa Wood, M.D., co-director of the Women's Center at Mass General Hospital, Boston, and chair of the ASE Public Relations Committee, explains these trends. The biggest is the expanding use of ultrasound and transesophageal echo (TEE) in the cath lab and hybrid OR for structural heart procedural navigation. Other trends include use of pocket ultrasound and new software advances to simlify and reduce the time it takes to use 3-D echo and make quantifications. For more information: www.dicardiology.com/article/ultrasound-sees-increasing-use-interventional-procedures
Siemens' syngo Aortic ValveGuide software enables transcatheter aortic valve replacement (TAVR) procedural guidance with integration of 3-D images on live fluoro imaging. This video shows the valve guidance technology used during the implantation of a Medtronic CoreValve device. For more information: www.DIcardiology.com
One of the most interesting educational exhibits at the recent American College of Cardiology (ACC) 2012 Scientific Session was "The Heart of Innovation" display on the show floor. The ACC in collaboration with marquee sponsor Philips Healthcare and several other industry leaders created this non-accredited, hands-on education experience. The exhibit explored the evolution of the standard-of-care for heart disease and heart failure caused by valvular disease. It looked at these issues through the lenses of personalized medicine, techno-biology, minimally invasive procedures and physician-patient engagement. The exhibit included technology from the past, present and future of healthcare. To incorporate a historical view, the entrance to the display included the ACC's special collection of historic artifacts encompassing medical books, stethoscopes and device technology dating back hundreds of years, including a stethoscope from 1535. This historical perspective was juxtaposed with a modern attendee experience that included the option to explore the entire exhibit with a specially provided iPad tour. The centerpiece was a mockup of a hybrid OR. It included a Corindus CorPath robotic cath lab intervention guidance system. Other partners included Maquet, showing a portable heart-lung machine the size of a small suitcase and the CFI Medical Solutions ZeroGravity radiation protection system. What made the hybrid OR particularly unique was that it was situated across from the Minimally Invasive Gallery, which featured many of the innovations that are driving procedures performed in the hybrid OR. The gallery encompassed solutions from Medtronic and Edwards Lifesciences, including Edward's breakthrough Sapien transcatheter heart valve. The display discussed current treatments and what the future technologies will likely be from the standard-of-care in the future.
Several interventional cardiology experts share their views on how fractional flow reserve (FFR) and optical coherence tomography (OCT) have changed their clinical practice. Increased accuracy and understanding of vessel lesion hemodynamics is cited as a way to better patient outcomes and lower healthcare costs.
The Crux inferior vena cava (IVC) filter was designed for easy deployment and later retrieval. This video clip shows retrieval of the device, which has has radio-opaque markets for easier visualization under angiography. IVC filters are designed for the prevention of pulmonary embolism.
The Crux inferior vena cava (IVC) filter was designed for easy deployment and later retrival. This video clip shows deployment of the device, which has has radio-opaque markets for easier visualization under angiography. IVC filters are designed for the prevention of pulmonary embolism.
Diagnostic and Interventional Cardiology Editor Dave Fornell discusses trends and shares his choices of the most innovative technologies shown on the floor of the American College of Cardiology (ACC) 2012 Scientific Session, held March 24-27 in Chicago. A couple of key trends were evident on the show floor — new technology to support trans-aortic valve replacement (TAVR) and the launch of new cardiovascular image and information systems (CVIS) to support healthcare's adoption of proposed Stage 2 meaningful use (MU) requirements. Other highlights include a balloon-inflatable TAVR/EVAR introducer sheath, 3-D intra-cardiac echo, a mobile angiography system for hybrid ORs and chocolate for heart health. For more information: www.DIcardiology.com
New evidence shows that with appropriate preparation, angioplasty can be safely and effectively performed at community hospitals without on-site cardiac surgery units. This was according to data presented from the CPORT-E trial during the American College of Cardiology (ACC) 2012 Annual Scientific Session. The study is the first randomized controlled trial to investigate elective cath lab angioplasty (or percutaneous coronary intervention, which includes stenting and balloon angioplasty) in community hospitals in the United States.
Results showed no difference in death rates among patients undergoing elective angioplasty at facilities with and without on-site cardiac surgery units. There were also no significant differences in rates of complications such as bleeding, renal failure and stroke. "The study shows that under certain circumstances, non-primary angioplasty can be performed safely and effectively at hospitals without on-site cardiac surgery," said Thomas Aversano, M.D., associate professor of cardiology at Johns Hopkins University and the study's lead investigator. Until a recent guideline change by the American College of Cardiology and the American Heart Association, community hospitals without cardiac surgery units performed only emergency angioplasties. Patients needing elective angioplasty were transferred to facilities with on-site cardiac surgery units. "The study supports and reinforces the [new] guidelines," said Aversano, adding that the findings can help hospitals and healthcare planners more efficiently allocate financial and human resources. The ability for community hospitals to offer elective angioplasty benefits patients, Aversano said. Other studies have shown that patients are often reluctant to transfer to a hospital that may be farther away or more expensive than their community hospital. "It's not just a question of patient convenience — it's also a question of access," he said.
For more information: www.DIcardiology.com
DAIC editor Dave Fornell explains some of the most innovative cardiovascular imaging technologies showcased by vendors at the Radiological Society of North America (RSNA) meeting in December 2011.
The Miracor Picso Impulse system is supposed to prevent reperfusion injury and the no-flow phenomenon following percutaneous coronary intervention (PCI) by increasing the microcirculation in the ischemic area. The device uses a balloon catheter in the coronary sinus to temporarily increase venous blood pressure.
Paramedics in Bellingham, Wash., used the Lucas device on patient Nancy Olson, who went into cardiac arrest following a heart attack. The device provided chest compressions while she was enroute to the hospital, helping to perfuse her brain and other organs, prior to her undergoing emergency percutaneous coronery intervention (PCI). For more information on the Lucas, visit www.physio-control.com.
In the largest randomized trial to compare radial access and femoral access for coronary angiography and intervention, researchers found radial access reduced rates of vascular complications, according to research presented at the American College of Cardiology (ACC) 2011 Scientific Session in New Orleans. The trial also found that radial access did not reduce the primary outcome measure of death, heart attack, stroke and non-CABG-related major bleeding compared to femoral access in the overall study population. The data showed these outcomes were equal for both femoral and radial access procedures.
"Interventional cardiologists can feel reassured both radial and femoral approaches are safe and effective," said Sanjit Jolly, M.D., M.Sc., assistant professor of medicine at McMaster University in Hamilton, Ontario, Canada. Radial access did lead to reductions in the primary outcome measure in patients who underwent the procedure at hospitals that conducted a high volume of radial procedures. For centers that were less experienced with radial access, Jolly said it was clear there is a learning curve, and operators got better and faster with radial procedures with more experience. "The take-home message is practice makes perfect," he said. Jolly explained the high-volume centers using radial access performed very well, but it was clear from the study operators need a lot of radial cases to increase performance. To read more, visit www.dicardiology.net/article/rival-trial-radial-access-reduces-vascular-complications
St. Joseph's Hospital of Atlanta created a radial access recover room that replaces beds and the sterile institutional hospital look with a more patient-friendly design. Transradial access is slowly gaining ground in the United States as more physicians make the switch due to greatly reduced bleeding complications, increased patient comfort and earlier ambulation. St. Joseph's Hospital of Atlanta is a big supporter of radial access and has taken the concept a step further by creating the first transradial recovery lounge in the country.
"I really see this as the future of cardiac care, not just as an alternative access route for percutaneous coronary intervention, but also to improve the patient experience and reduce their hospital stay," said Jack P. Chen, M.D., FACC, FSCAI, FCCP, director of cardiac research, St. Joseph's Translational Research Institute, Saint Joseph's Heart and Vascular Institute, Atlanta. A trend in medical facility design over the past 15 years has moved away from the sterile, institutional look of traditional hospitals. Instead, more inviting, warm and friendly looking facilities are being built to make patients feel more comfortable. This concept is now being applied to the cath lab recovery room. Use of radial access allows for immediate ambulation, and thus a major revision to recovery room design, replacing beds with couches and recliner chairs. St. Joseph's Hospital is the first in the United States to build a cafe-like lounge exclusively for radial access patients.
Chen took the idea from Ferdinand Kiemeneij, M.D., department of interventional cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. He created the first radial access recovery room in Europe after getting the idea from a KLM airline lounge. "The idea is to build a cafe-type atmosphere to reduce the anxiety associated with invasive heart procedures," Chen said. "When I first approached the hospital administration with this idea, they required a bit of convincing. However, after seeing the patient satisfaction and alleviation of complications stemming from this technique, all were in agreement that this concept may well be the wave of the future."
He said the hospital embraces the radial access approach as a new frontier in interventional cardiology and agreed to build the new recovery area. "To me, this rounded out the picture of a more patient-friendly cardiology program for what is essentially a minimally invasive catheterization/interventional procedure," Chen said. Patients sit in the lounge chairs for 30 minutes to an hour, only to recover from the sedation. The patients are then allowed to ambulate in their street clothes. They can walk around or sip a cappuccino, Chen said.
The recovery room has comfortable reclining chairs instead of beds and there are couches and coffee tables topped with magazines and newspapers. The recliners have attached swing-up tabletops where patients can put a laptop computer and check their e-mail or surf the Internet. The idea is to eliminate the sterile, institutional appearance of most recovery rooms and to relax the patient with a more inviting atmosphere. â??We are trying to take the hospital out of the equation," Chen said. "Patients are much more at ease than they would be in a typical hospital setting. To allow them to put their street clothes on really reduces the anxiety they have." The lounge was showcased and visited by many cardiologists from around the country during the American College of Cardiology (ACC) Annual Scientific Sessions in March 2010, which were held in Atlanta.