This is an example of the Siemens Corindus CorPath Cath lab robotic system being used for a percutaneous coronary intervention (PCI) stent implant simulation on the expo floor at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The system is mounted to the rail of the cath lab patient table and is manually loaded with catheters. The operator sits in a lead-lined booth outside the radiation field of the C-arm and uses joysticks to manipulate the catheters and advance them through vessels. The operators has the same controls for contrast and C-arm movement as they do using the tableside controls.

The main advantages of this systems are very precise catheter movements and removing the operator from the radiation field, so they can perform the procedure sitting down and without the need to wear heavy protective aprons.

The system is being tested to enable remote expert operators at one hospital to use high speed internet connections to perform a robotic PCI at another hospital many miles aways.
Read more 

Related Cardiovascular Robotics Content:

VIDEO: Standardizing PCI Through Smart Robotic Procedural Automation

Final Results of the Multicenter PRECISION GRX Study of the CorPath in a real-world population across a spectrum of lesion complexity — SCAI 2021 late-breaker

First-in-Human Telerobotic Coronary Intervention Procedures Published in EClinicalMedicine

Robocath Successfully Carries Out First Robotic Coronary Angioplasties in Humans

Corindus Vascular Robotics to Be Acquired by Siemens Healthineers

Corindus CorPath GRX Used in Live Complex Robotic-Assisted Coronary Intervention at EuroPCR 2019

Stereotaxis Announces Next-generation Robotic Magnetic Navigation and Imaging Systems

Reducing Physician Radiation Dose With Robotics

Corindus Seeking Neurovascular Intervention Clearance for CorPath GRX Vascular Robotic System

Corindus CorPath Used in World's First-in-Human Telerobotic Coronary Intervention

Robots in the Cath Lab

Aaron Baggish, M.D., director of the cardiovascular performance program, Massachusetts General Hospital. He was on a 2020 American Heart Association (AHA) meeting panel discussion on the topic of the lingering myocardial involvement after COVID-19 (SARS-CoV-2) infection. He said there appears to be some long-term effects in the body from COVID, including the heart and vascular system, but it is unknown how long these effects may last. These patients are now being referred to as COVID "long-haulers."

The AHA late-breaking studies included four that pertained specifically to COVID-19. Three of these pertained specifically to the AHA COVID-19 Cardiovascular Disease Registry. It has been collecting data on patients with cardiac co-morbiditities or cardiac involvement since April to provide insights into these patients hospitalized with the novel coronavirus. One study was a review of the registry, a second looked at the racial and ethnic disparities in severe COVID patients. The third looked at the association of body mass index and death, mechanical ventilation and cardiovascular outcomes.

Read more about these three studies in the article COVID-19 Cardiovascular Registry Details Disparities Among Hospitalized Patients.

The fourth study looked at the overall of cardiovascular risk factors in more than 14,000 COVID-19 patients. It showed in-hospital mortality ranged from 28.5 percent for patients with hypertension to 28.6 percent for those with diabetes, 25.5 percent for those with coronary artery disease, and 38.4 percent for those with heart failure.

Read more in the article COVID-19 Patients With Cardiovascular Disease Have In-hospital Mortality Rates of 25 to 38 Percent. 

Find more AHA news, video, and late-breakers

VIDEO: Long-term Cardiac Impacts of COVID-19 Two Years Into The Pandemic (Jan. 2022) — Interview with Aaron Baggish, M.D.

The Long-term Cardiovascular Impact of COVID-19

VIDEO: What Are The Long-term Cardiac Impacts of COVID-19 Infection — Interview with Todd Hurst, M.D.

COVID-19 Changes Properties Blood Cells

COVID-19 Blood Vessel Damage May Cause Brain Fog and Other Long-hauler Symptoms

Find more cardiology related COVID-19 news

Chuck Simonton, M.D., chief medical officer at Abiomed, discusses some of the new technologies and clinical trials the company is working on and highlighted hemodynamic presentations at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting.

In this interview Simonton discusses:
   • The new Impella 5.5 device
   • The new Impella ECP expandable pump that collapses to a very small diameter to aid vascular access is about to start first-in-human trials.
   • Smart Assist technology that will incorporated artificial intelligence (AI) to better monitor Impella patients.
   • The Door to Unloading (DTU) Trial that is using Impella first in STEMI patients prior to PCI to prevent reperfusion injury
   •The PROTECT III and IV trials. 

Prior Abiomed, Simonton was the CMO at Abbott Vascular, and was a practicing interventional cardiologist for nearly 30 years at Duke University Medical Center and then at the Sanger Clinic. At Sanger he created his own research team to study patient outcomes following the use of new cardiac technologies. He also founded the Carolinas Cardiovascular Research Foundation at the Carolinas Heart Institute, now part of Atrium Health.
 

Find more TCT news, video and the late-breaking studies

The COMPARE CRUSH Trial looked at the effect of per-hospital crushed prasugrel tablets in patients with STEMI planned for primary percutaneous coronary intervention (PCI).[1] This video is of the press conference presention of this late-breaking study by doctor George Vlachojannis, from UMC Utrecht, at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. 

The idea was to crush the tablets to enable faster anti-later inhibition, but the findings of this study showed it did not improve TIMI 3 flow on first angiography or ST-segment resolution at 1 hour post PCI.

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

Reference:

1. Vlachojannis GJ, Vogel RF, Wilschut JM, Lemmert ME, Delewi R, Diletti R, van Vliet R, van der Waarden N, Nuis RJ, Paradies V, Alexopoulos D, Zijlstra F, Montalescot G, Angiolillo DJ, Krucoff MW, Van Mieghem NM, Smits PC. COMPARison of pre-hospital CRUSHed vs. uncrushed Prasugrel tablets in patients with STEMI undergoing primary percutaneous coronary interventions: Rationale and design of the COMPARE CRUSH trial. Am Heart J. 2020 Jun;224:10-16. doi: 10.1016/j.ahj.2020.03.005. Epub 2020 Mar 11.

David Cohen, M.D., presents late-breaking data from the STS/ACC Transcatheter Valve Registry (TVT) showing the impact of using cerebral embolic protection devices during transcatheter aortic valve replacement (TAVR). This is the press conference presentation followed by an expert panel discussion at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting.

The stroke rates were initially high in TAVR compared to surgical aortic valve replacement (SAVR), but these rates have decreased in recent years as operators become more proficient during the procedures and the stroke rates are now comparable or lower than SAVR.

Cerebral embolic protection devices were developed to prevent emboli knocked off the aortic walls and from the aortic valve from traveling to the brain. However, this review of embolic protection device performance and use showed 66 percent of the 700 sites in the TVT Registry report not using these devices.

The rate of in-hospital stroke in the embolic protection group of patients was 1.39 percent. The rate of stroke in patients without embolic protection was 1.54 percent. There was no difference inn the rates of death, stroke, major bleeding or device success between these two groups, Cohen said.

The study also included a propensity-weighted analysis where the embolic group has a stroke rate of 1.3 percent and the no protection device group at 1.58 percent. 

Cohen said there was not a significant reduction in in-hospital or 30-day stroke rates. While there its a slight signal toward fewer strokes with embolic protection, he said the findings show clinical equipoise and provide strong rational for ongoing, large-scale randomized, controlled trials to see if embolic protection devices offer meaningful clinical benefit.

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

Related TAVR Content:

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

Key TAVR Takeaways From ACC 2020

U.S. TAVR Outcomes Need Improvement Based on TVT Registry Analysis

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

Doctor Hans-Josef Feistritzerm, Heart Center of Leipzig, Germany, presents data on the use of general vs. local anesthesia in transcatheter aortic valve implantation (TAVI) from the late-breaking SOLVE-TAVI one-year outcomes trial. This is the press conference at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. It is followed by an expert panel discussion on the merits and meaning of the results.

The results showed both approaches are safe to use and the outcomes are good.

The trial randomized patients to either self-expandable or balloon-expandable transcatheter aortic valve replacement (TAVR) valves and the procedures used either general or local anesthesia. TAVR centers have been moving toward the procedure becoming a same day surgery to reduce overnight admissions and send them home as an out patient procedure. This can be accomplished using a local anesthesia if transesophageal echo (TEE) is not needed. However, many still use TEE or there are other factors that make this approach more appealing. Local anesthesia generally has a faster recovery time and reduces  potential complications in sicker and older patients.

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

Related TAVR Content:

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

Key TAVR Takeaways From ACC 2020

U.S. TAVR Outcomes Need Improvement Based on TVT Registry Analysis

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

Gregg Stone, M.D., presents the results of the PROSPECT ABSORB Trial in a press conference at the 2020 ranscatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. 

The PROSPECT ABSORB Trial was a randomized evaluation of vulnerable plaques using the Abbott Absorb fully bioresorbable stent. The hypothesis of the trial  was to treat lesions prior to plaque ruptured to avoid heart attacks, rather than treating them after plaque rupture when a potential infarct and permanent heart damage is caused. Patients were randomized to percutaneous coronary intervention (PCI) using an Absorb bioresobable vascular scaffold (BVS) stents vs. guideline directed medical therapy (GDMT).

This is the first study that proactively identifies and preemptively treats vulnerable plaques. 

Lesion related MACE events 4 years showed medical therapy alone resulted in 10.7 percent events and the BVS treat patients were 4.3 percent. Stone said the favorable BVS MACE rates warrants a larger, adequately powered randomized trial to determine if PCI treatment of focal vulnerable plaques improves patient outcomes. 

The study looked at periprocedural anticoagulation during percutaneous corona intervention in AMI patients. There has been conflicting results reported between several trials looking at which drug is best for anticoagulation during cath procedures.

This study pooled data from 8 studies that included more than 27,000 patients. The data included both STEMI and NSTEMI patients.

The pool analysis found STEMI patients, bivalirudin was associated with reductions mortality, serious bleeding and NACE events, despite higher rates of myocardial infarction  (MI) and stent thrombosis compared with heparin. The mortality benefit of bivalirudin was pronounced in patients with a post-PCI bivalirudin infusion to mitigate MI and stent thrombosis risks. 

In NSTEMI patients, bivalirudin was associated with a reduction in 30 day serious bleeding events, but similar rates of mortality, MI and stent thrombosis compared to heparin.

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

This is an example pf the Shockwave Medical Intravascular Lithotripsy (IVL) catheter system designed to break up heavily calcified plaque in coronary and peripheral vessels. The system uses sonic waves that penetrate the vessel wall and crack the calcium without causing vessel trauma, which commonly occurs with atherectomy and high pressure balloon angioplasty.  

This demonstration was on the exhibit floor of the 2019 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting. The material used in the demonstration are gypsum beads.

Related Content on Intervascular Lithotripsy:

Shockwave Technology to Sonically Bust Calcified Coronary Lesions Shows Safety and Efficacy in U.S. Pivotal IDE Trial

FDA Grants Shockwave Medical Breakthrough Status for Coronary Intravascular Lithotripsy

Intravascular Lithotripsy: Will This New Investigational Technology Crack Calcium’s Code in the U.S.? — by Dean Kereiakes, M.D.

Intravascular Lithotripsy May Offer Solution for Calcified Coronary Lesions — By Azeem Latib, M.D.

VIDEO: Breaking Up Calcified Lesions Without Vessel Trauma — Interview with Todd Brinton, M.D.

Shockwave Launches Coronary Intravascular Lithotripsy in Europe

Lithotripsy Safe and Effective in Calcified Stenotic Peripheral Arteries

Shockwave Initiates U.S. Pivotal Study for Coronary Intravascular Lithotripsy

Juan F. Granada, M.D., CEO of the Cardiovascular Research Foundation (CRF) explains structural heart innovations and new technologies have exploded in the past few years after the success of transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVR) with the MitraClip. 

Granada said device technologies in development for interventional heart failure therapies, mitral valve and tricuspid replacements and repairs have grown rapidly in just the past couple years. He said the Transcatheter Cardiovascular Therapies (TCT) 2020 received a very large number of presentation proposals for new structural heart innovations.

Hear more about the TCT 2020 virtual meeting in the VIDEO: What to Expect at the Virtual TCT 2020 Meeting, an interview with Juan Granada.

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.
 

Related Drug-eluting Balloon Content:

Recent Developments in Drug-Coated Balloons

Comparison Chart of Drug-eluting Balloons (requires login but is free to signup)

Positive Data for the Ranger Drug-coated Balloon and Eluvia Vascular Stent

LEVANT Trial Data Shows Safety of Drug-Coated Balloon Shown

Drug-coated Balloon Maintains Good Outcomes in 4-Year IN.PACT Global Study Data

No Difference Between Drug-coated Balloons and Plain Balloons After Laser Atherectomy

Philips Shares Three-Year Results for Stellarex .035 Drug-Coated Balloon

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

Advanced visualization company Medis recently purchased Advanced Medical Imaging Development S.r.l. (AMID), which developed software to automatically track and measure strain in echocardiograms. That technology is now being adapted for strain imaging in CT and MRI. Using this imaging data, the software also can noninvasively derive pressure gradient loops and curves, similar to using invasive pulmonary arterial (PA) hemodynamic pressure catheters. This information is useful in monitoring critically ill patients on hemodynamic support and to monitor worsening severity of heart failure. 

The technology was discussed at the 2020 Society of Cardiovascular Computed Tomography (SCCT) virtual meeting. Examples of this technology are presented in this video. 
 

Find more news and video from SCCT 2020

VIDEO: Photon Counting Detectors Will be the Next Major Advance in Computed Tomography
 

Todd Villines, M.D., FACC, FAHA, MSCCT, said photon counting CT detectors were a key new technology discussed at the Society of Cardiovascular Computed Tomography (SCCT) 2020 virtual meeting. He said the technology will likely replace conventional CT detectors in the next decade.

These new detectors also can take a single scan and bin the various energies to reconstruct a range of mono-energtic scan renderings similar to dual-energy CT, but on a wider spectrum of kV levels. This spectral aspect of photon counting also allows material decomposition based on the chemical elements that make up various materials in the scan, including calcium and metals that make up stents, orthopedic implants and replacement heart valves. This enables easier, automated removal of metal blooming artifacts and the ability to clearly image inside calcified arteries.

Villines is the Julian Ruffin Beckwith Professor of Medicine, Division of Cardiovascular Medicine, University of Virginia, editor-in-chief of the Journal of Cardiovascular CT (JCCT),  and SCCT past-president.

Other Key Trends and Technology at SCCT:

Top 9 Cardiovascular CT Studies in Past Year 

VIDEO: Increased Use of Cardiac CT During the COVID-19 Pandemic

VIDEO: Coronary Plaque Quantification Will Become Major Risk Assessment

VIDEO: Key Cardiac CT Papers Presented at SCCT 2020

VIDEO: Artificial Intelligence to Automate CT Calcium Scoring and Radiomics

Low-attenuation Coronary Plaque Burden May Become Next Big Cardiac Risk Assessment

Impact of Cardiac CT During COVID-19

Todd Villines, M.D., FACC, FAHA, MSCCT, explains how coronary plaque assessment will become a new risk assessment tool in cardiac CT. This was a key take away during the Society of Cardiovascular Computed Tomography (SCCT) 2020 virtual meeting in July. He is the Julian Ruffin Beckwith Professor of Medicine, Division of Cardiovascular Medicine, University of Virginia; editor-in-chief of the Journal of Cardiovascular CT (JCCT), and SCCT past-president. 

While basic plaque assessments have been available for several years on CT vendor and third-party advanced visualization software, it lacked automation standardization for what various values meant and clinical evidence it was relevant. However, several speakers in SCCT sessions said that is now changing, with more specific analysis being tested clinically and automation using artificial intelligence. 

Several key opinion leaders in cardiac CT said this new information and automation will likely lead to a revision of the current CAD-RADS scoring system used by radiologists and cardiologists when assessing the coronary event risk of patients. They are calling for the new CAD-RADS 2.0 to include a detailed plaque assessment.  

Related SCCT Key Trends and New Technology Content:

Low-attenuation Coronary Plaque Burden May Become Next Big Cardiac Risk Assessment

Top 9 Cardiovascular CT Studies in Past Year 

VIDEO: Increased Use of Cardiac CT During the COVID-19 Pandemic

VIDEO: Key Cardiac CT Papers Presented at SCCT 2020

VIDEO: Photon Counting Detectors Will be the Next Major Advance in Computed Tomography

VIDEO: Artificial Intelligence to Automate CT Calcium Scoring and Radiomics 

Impact of Cardiac CT During COVID-19
 

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.

Interview with Andrew D. Krahn, M.D., FHRS, head of the division of cardiology at St. Paul’s Hospital, and professor of medicine at the University of British Columbia. He is also vice president of the Heart Rhythm Society (HRS). He moderated the late-breaking sessions at 2020 HRS virtual meeting and explains the highlights of the new technologies and data presented. 

Technologies include a nasal spray to stop supraventricular tachycardia, pulsed field ablation technology that may offer improvement over current technology, subcutaneous ICD (S-ICD) technology performing as well as traditional transvenous lead ICDs, contact force sensing ablation improves outcomes, use of smart watches to help atrial fibrillation patients adhere to oral anticoagulation therapy, and the first pacemaker to interface with the patient's smart phone.

Watch another interview with Krahn in the VIDEO: Insights Into How HRS Organized its Virtual Meeting.

Find a complete list of the Heart Rhythm 2020 meeting late-breaking studies with links to articles on each.

Find more news and video from the Heart Rhythm Society.
 

Interview with Geoffrey Rose, M.D., president of Sanger Heart and Vascular Institute with Atrium Health, in Charlotte, North Carolina, and a board member with the American Society of Echocardiography (ASE). He explains the impact of COVID-19 (SARS-CoV-2) on the cardiovascular service line and cardiac imaging. He said the virus has led to use of computed tomography (CT) not only as the frontline cardiovascular imaging modality to evaluate chest pain, but also for COVID-19 pneumonia imaging.

Rose said cardiac ultrasound is still used, but requires full personal protective equipment (PPE) and often abbreviated exams because of the close proximity of the sonographer and patient when performing echocardiograms. This has given rise to using dedicated point-of-care ultrasound (POCUS) systems to answer specific clinical questions quickly. Smart-phone based POCUS systems that use an app and a transducer plugged into the phone enable basic echo exams or evaluation of other parts of the anatomy quickly without the need to immediately sterilize an entire cart-based ultrasound system. These small systems also can be completely enclosed inside a transducer sheath and the phone and single transducer are much easier and faster to wipe down. He said the quality of the exams are not as good as fully enabled echocardiography systems, but it allows for quick assessments of ejection fractions and to triage if the patient needs more advanced imaging if the basic questions cannot be answered.

Since hospitals have shut down now for about two months, postponing normal checkups, and elective exams and procedures, Rose said doctors still need to visit with patients who have chronic conditions. Sanger and Atrium Heath modified its ambulatory electronic medical record (EMR) and is using video conferencing to perform virtual appointments now for the majority of these patients. He said telemedicine was not widely used before COVID-19 in his hospital system, but the pandemic will likely alter the care model for the future, with more telemedicine visits being used even after epidemic is over. He said use of POCUS and CT as frontline cardiac imaging modalities will also likely remain in place after the pandemic because of the efficiencies in care these technologies offer.

Related Coronavirus Content:

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

Cardiac Imaging Best Practices During the COVID-19 Pandemic

RSNA Publishes COVID-19 Best Practices for Radiology Departments

ASE Guidelines for the Protection of Echocardiography Providers During the COVID-19 Outbreak
 

New CT Scoring Criteria for Timely Diagnosis, Treatment of Coronavirus Disease

FDA Issues New Policy for Imaging Systems During COVID-19

VIDEO: COVID-19 Precautions for Cardiac Imaging —  Interview with Stephen Bloom, M.D.

A Review of Studies Cautions Against Chest CT for Coronavirus Diagnosis

New Research Finds Chest X-ray Not Reliable Diagnostic Tool for COVID-19

VIDEO: Radiology Industry Responding to COVID-19

University of Washington Issues Radiology Policies for COVID-19

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic — Interview with Hicham Skali, M.D.

New Research Highlights Blood Clot Dangers of COVID-19

Survey Reveals Most Medical Practices are Now Using Telehealth Due to COVID-19

CMS Offers Recommendations on Reopening Healthcare in Areas of Low COVID-19 Cases

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

Radiology Lessons for Coronavirus From the SARS and MERS Epidemics

Radiologists Describe Coronavirus CT Imaging Features

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

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

Ehtisham Mahmud, M.D., FSCAI, president of the Society for Cardiovascular Angiography and Interventions (SCAI) and chief, Division of Cardiovascular Medicine at UC San Diego Medical Center, explains the SCAI precaution guidelines for treating patients in the cath lab under the COVID-19 pandemic.

He explains the how cardiology departments in the U.S. are operating to treat acute patients during novel coronavirus (COVID-19, SARS-CoV-2) containment efforts. 

The guidelines are outlined in the document "Considerations for Cardiac Catheterization Laboratory Procedures During the COVID‐19 Pandemic" can be accessed online in the SCAI journal Catheterization and Cardiovascular Interventions.[1]

Other Impact of COVID-19 on Cardiology Content:

How to Manage AMI Patients During the COVID-19 Pandemic

VIDEO: Impact of COVID-19 on the Interventional Cardiology Program at Henry Ford Hospital — Interview with William O'Neill, M.D.

VIDEO: 9 Cardiologists Share COVID-19 Takeaways From Across the U.S.

VIDEO: Multiple Cardiovascular Presentations of COVID-19 in New York — Interview with Justin Fried, M.D.

Image Gallery Showing Impact of the COVID-19 Pandemic

ACC COVID-19 Clinical Guidance For the Cardiovascular Care Team

VIDEO: COVID-19 Precautions for Cardiac Imaging — Interview with Stephen Bloom, M.D.

Rapid Drop in Heart Attacks and Stroke at Hospitals Concerns ACC 

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — an interview with SCCT President Ehtisham Mahmud, M.D.

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D.

The Cardiac Implications of Novel Coronavirus

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

Reference:

1. Molly Szerlip  Saif Anwaruddin  Herbert D. Aronow, et al. Considerations for Cardiac Catheterization Laboratory Procedures During the COVID‐19 Pandemic Perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates. Catheterization and Cardiovascular Interventions. First published:25 March 2020. https://doi.org/10.1002/ccd.28887.

Ehtisham Mahmud, M.D., FSCAI, president of the Society for Cardiovascular Angiography and Interventions (SCAI) and chief, Division of Cardiovascular Medicine at UC San Diego Medical Center, explains the new American College of Cardiology (ACC) and SCAI precaution guidelines for treating transcatheter aortic valve replacement (TAVR) patients in the cath lab during the COVID-19 pandemic.

He explains recommendations for how structural heart programs can continue to treat acutely ill patients during novel coronavirus (COVID-19, SARS-CoV-2) containment efforts. The key message in the guidelines is to defer patients who can wait until containemnt efforts loosen in the coming months, while acute patients who are very sick should be treated.

The guidelines are outlined in the document "Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID‐19) Pandemic: An ACC /SCAI Consensus Statement." can be accessed online in the SCAI journal Catheterization and Cardiovascular Interventions.[1]

Related COVID-19 Cardiology Content:

VIDEO: Impact of COVID-19 on the Cardiovascular Program at Henry Ford Hospital — Interview with William O’Neill, M.D.

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

New York City Physicians Note Multiple Cardiovascular Presentations of COVID-19

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — Interview with Ehtisham Mahmud, M.D.

ACC COVID-19 recommendations for the cardiovascular care team

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

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

FDA Approves ECMO to Treat COVID-19 Patients

COVID-19 STEMI Registry Created to Study Acute Cardiovascular Effects of the Virus

Image Gallery Showing Impact of the COVID-19 Pandemic

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic

The Cardiac Implications of Novel Coronavirus

Reference:

1. Pinak B. Shah, Frederick G.P. Welt, Ehtisham Mahmud, et al. Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID‐19) Pandemic: An ACC /SCAI Consensus Statement. Catheterization and Cardiovascular Interventions. First published:06 April 2020 https://doi.org/10.1002/ccd.28910.

Basel Ramlawi, M.D., chairman of The Heart and Vascular Center at Valley Health System in Virginia, director of the Advanced Valve and Aortic Center, and co-principal investigator for an American College of Cardiology (ACC) 2020 Scientific Session late-breaking trial that looks at the clinical implications of TAVR in patients who have bicuspid aortic valve leaflets offers an overview of the data from ACC.20.

Patients with bicuspid, or two-leaflet, aortic valves who undergo transcatheter aortic valve replacement (TAVR) procedures had a high rate of success and low risk of death or disabling stroke at 30 days, according to new data presented at the ACC 2020. The session was part of the virtual, online late-breaking presentations, since the live meeting was cancelled due to the spread of COVID-19. 

TAVR has become increasingly popular in recent years as a less-invasive alternative to open-heart valve replacement surgery. However, few studies have examined its safety in patients with a bicuspid valve, a genetic variation of the aortic valve in some patients, rather than the typic three-leaflet valve. The condition affecting roughly 2-5 percent of people in which two of the three flaps in the aortic valve are fused together.

A bicuspid valve is more likely to become stenosis. Valve replacement, either through TAVR or open-heart surgery, is the main treatment option available for people with severe aortic stenosis, which causes fatigue and other symptoms and raises the risk of other heart problems when left untreated. The new study is the first to prospectively examine TAVR’s safety for treating severe aortic stenosis in relatively young, healthy patients—in whom open-heart surgery would pose a low risk—who have a bicuspid valve. It also is one of the first studies involving such patients in which doctors used a newer self-expanding artificial valve.

“This clearly has clinical implications with patients with bicuspid valves who want TAVR," said Basel Ramlawi, M.D., cardiothoracic surgeon at Valley Health System in Virginia and the study’s co-principal investigator. "TAVR with a self-expanding prosthesis is a very viable and safe procedure in low-risk bicuspid patients and achieved excellent early results. Though additional follow-up is necessary to determine long-term outcomes, early results suggest this procedure can be performed successfully in low-risk individuals with a good outcome.” 

The study prospectively tracked 150 patients who underwent TAVR at 25 medical centers in the U.S. 

Read the aricle on the study

Find more ACC news and video

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. 

Read Mahmud's SCAI President's letter The Evolving Pandemic of COVID-19 and Interventional Cardiology

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