FIT Perspective | SCAI: Key Takeaways for the Interventional FIT

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As a soon-to-be interventional cardiology fellow, I was brimming with excitement when I set off for the annual meeting of the Society for Cardiovascular Angiography and Interventions (SCAI) to present my research and learn about the state-of-the-art in interventional cardiology. After spending four days in San Diego at the meeting, I’m even more invigorated to join this exciting and important field.

Ehtisham Mahmud, MD, FACC, program chair of SCAI, kicked off the meeting with an energetic welcome that highlighted the teamwork from a broad array of individuals from across the country and the world who contributed to the development of the curriculum for SCAI 2018. The breadth of partnering organizations, including the Heart Failure Society of America, Cardiovascular Research Foundation and the International Conference for Innovations emphasized to me the wide scope of practice of the modern interventional cardiologist — it’s not just about PCI of type A lesions! Interventional cardiology nowadays encompasses a wide diversity of procedures — from transcatheter mitral valve replacement to catheter-based thrombectomy for pulmonary embolism.

Along with my co-investigators, I had the chance to present our research poster titled Expedited Removal of a Radial Hemostatic Compression Device Following Cardiac Catheterization Is Safe and Associated With Reduced Time-To-Discharge. Our study investigated the optimal time of compression using the TR Band (Terumo Interventional Systems, Somerset, NJ) following transradial cardiac catheterization by comparing 120 minutes of compression with 60 minutes and 30 minutes in terms of bleeding, hematoma formation and major complications.

Our investigation was conceived from the observation that there is a scarcity of data to guide how long these devices should be applied and also from the discovery of a striking heterogeneity of compression times used by cath labs across the country. Look for the details in our manuscript to be published soon.

As for innovations in the field, the exhibition hall provided more than enough for the technophile interventionalist. An Impella (Abiomed Inc., Danvers, MA) simulator allowed operators to practice their technique at inserting the percutaneous left ventricular assist device. Many attendees also had the chance to participate in the trans-septal puncture workshop.

Perhaps the most cutting-edge simulator was the Corindus CorPath GRX (Corindus Vascular Robotics, Waltham, MA), a device for robotic-assisted PCI. During a CorPath-assisted PCI, the guide catheter, coronary wire and balloon/stent are controlled remotely by physicians using joysticks and a touch screen interface. Could my childhood video game skills finally prove more valuable than ever anticipated? Using the CorPath GRX simulator, I had the chance to cross a virtual lesion — and I was left wondering if this could be the future of the field.

Corindus advertises robotic-assisted vessel diameter measurement and more precision positioning than even the steadiest human hands. An added benefit is the ability to perform all of this functionality in the radiation-shielded control room. The PRECISE trial has already demonstrated the device’s safety and feasibility and multiple clinical trials of the device are planned in 2018.

Case presentations were another valuable component of the conference. The most eye-opening case for me was one of a femoral artery perforation during a TAVR. Initially, all seemed to be going as planned and the valve was deployed without much trepidation. After removal of the valve deployment apparatus, the patient experienced new hypotension. Angiography of the femoral artery confirmed the feared complication — femoral artery perforation with active extravasation of contrast.

Although the atmosphere in the cath lab was tense when the complication was discovered, the operator shifted focus — and skill set — quickly to address the problem immediately. Instead of relying on calling vascular surgery, the team employed peripheral interventional skills and they were able to first tamponade the bleeding vessel and then definitively address the problem with a covered stent.

This particular case resonated with me and the clear takeaway is this: Diversifying our skills is important to become a well-rounded interventional cardiologist, as opposed to focusing on a single niche.

The Fellows Summit, a specialized session for fellows in training (FITs), was the most useful and enjoyable part of the meeting. As I approach my interventional fellowship, I don’t yet have an informed opinion on, say, the optimal technique for bifurcation stenting. So a set of curricula and activities for FITs like me that emphasized the basics and fellow-specific issues was especially appreciated. There we heard from the likes of Morton J. Kern, MD, FACC, who spoke about the holistic approach to the cath lab patient: Speak plainly (using fourth grade vocabulary, no matter the level of education of the patient), sit at the bedside (instead of standing) and make sure to recap with the patient and family after the procedure.

Although I gained a substantial amount of technical knowledge about the field over the course of my time at SCAI, the true benefit of the meeting seems to be the collaboration with colleagues from all over the world. Not only did I meet some of the most influential and established figures in the field, but just as importantly I was able to connect with other FITs who share my same excitement for the future of the field. The future looks bright.

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Mark K. Tuttle, MD, is a fellow in the Division of Cardiovascular Medicine at Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA. In July, he will continue his training at BIDMC as an interventional cardiology fellow.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging

Keywords: ACC Publications, Cardiology Interventions, Fellowships and Scholarships, Research Personnel, Femoral Artery, Heart-Assist Devices, Mitral Valve, Transcatheter Aortic Valve Replacement, Cardiac Catheterization, Research, Angiography, Protective Devices, Thrombectomy, Heart Failure, Hemostatics, Pulmonary Embolism, Hematoma, Hypotension, Stents, Curriculum, Percutaneous Coronary Intervention, Educational Status

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