Highlights

CRT 2020 – Day 1 Wrap-Up


CRT 2020 kicked off its first day in a new venue, the Gaylord National Conference Center in National Harbor, Maryland, with five daylong courses, two live cases and many abstract and interesting case presentations.

CRT PHYSIOLOGY

One of the live cases was in the CRT Physiology course. The case was broadcast from St. Francis Hospital in Roslyn, New York. Allen Jeremias, MD, and Richard Shlofmitz, MD, demonstrated physiology guided percutaneous coronary intervention using resting full-cycle ratio (RFR) with pullback. Shlofmitz mentioned he typically uses a buddy wire when performing physiologic assessment in complex lesions to maintain wire position following pullback. Shlofmitz determined that the calcium in the target vessel should be fractured using orbital atherectomy. While he was doing that, he was asked by the panel why he chose orbital as opposed to rotational atherectomy.

Shlofmitz emphasized that both rotational and orbital atherectomy have their advantages but that in his experience, orbital atherectomy works well for plaque modification. After the orbital atherectomy, Shlofmitz used optical coherence tomography (OCT) imaging to measure the vessel from external elastic lamina (EEL) to EEL, and rounded down to select 3.5-mm-diameter stents and expanded them with post-dilatation with a high-pressure non-compliant balloon. The target lesion involved the proximal and mid-RCA, so he decided to use two stents. OCT demonstrated multiple calcium fractures following lesion preparation with orbital atherectomy.

As he performed a second OCT run, Shlofmitz explained to the audience that he finds OCT takes much less time – and less contrast – and improves accuracy in comparison with acquiring multiple coronary angiography images.

Course co-director Justin E. Davies, MD, PhD, said that Shlofmitz and Jeremias did an “excellent job demonstrating OCT and physiology guidance in the case.”

CARDIOGENIC SHOCK RESEARCH

The Cardiac Safety Research Consortium met to discuss advancing pathways in cardiogenic shock research.

In this all-day meeting, which was hosted by experts in the field and industry, the discussion touched on several aspects, including but the high mortality rate in cardiogenic shock patients, how to rapidly identify and triage shock patients, and how and when to obtain informed consent.

Consortium members discussed the current definitions and the need for uniform definition as they addressed the limitations of the Society for Cardiovascular Angiography and Interventions staging system of cardiogenic shock. They are currently processing the draft of a manuscript that proposes a new, consistent definition for different stages of cardiogenic shock that can be used in randomized trials. The Academic Research Consortium also advised that it is seeking volunteers for ongoing shock research pathways.

CRT 2020 Course Chairman Ron Waksman, MD, said the new definition should focus on the disease rather than treatment strategy based on stage. He proposed a model incorporating hemodynamic data and clinical presentation.

The session ended with Sunil V. Rao, MD, discussing resources for shock network research and William Abraham, MD, Judith Hochman, MD, Holger Thiele, MD, and other experts discussing next steps in advancing research in cardiogenic shock.



MITRAL VALVE REPAIR WORKSHOP

This workshop covered a wide range of topics concerning the treatment for mitral regurgitation (MR).

Molly Szerlip, MD, offered tips on how to prevent mitral stenosis after using a mitral clip and how to treat stenosis should it occur.

Both Michael Rinaldi, MD, and Wayne Batchelor, MD, discussed which MitraClip to use. Batchelor presented data showing that overall, the MitraClip XTR is used in about 45% of cases and the MitraClip NTR is used in about 40% of cases, with the balance being both kinds. Primary (degenerative) MR saw higher use of the XTR (48%), while more than half of secondary (functional) MR cases were treated with the NTR.

Batchelor added that while the interventional cardiology community has greeted MitraClip with enthusiasm in the wake of its positive results in the COAPT trial, “the message … still has not resonated with the heart failure community.”

CRT VALVE IMAGING

A good portion of the second half of this course focused on imaging the aortic valve. Danny Dvir, MD, said the diagnosis of clinically relevant leaflet thrombosis after transcatheter aortic valve replacement (TAVR) should be guided by symptoms and signs of heart failure or embolism, or both, with careful workup of elevated mean gradients. He added that 4-D computed tomography and transesophageal echocardiography can inform the clinical differential for a post-TAVR transvalvular gradient.

Gaby Weissman, MD, discussed how operators can deal with discrepancies between imaging modalities before and after TAVR. He said clinicians should keep in mind that the modalities are complementary and that they should always refer to the patient’s raw data when in doubt. He added that the heart team should have access to expertise in multiple imaging modalities to help come to the best decision for each individual patient.

LEFT ATRIAL APPENDAGE CLOSURE FORUM

The afternoon portion of this course focused largely on practical issues concerning left atrial appendage (LAA) closure.

Sameer Gafoor, MD, presented data showing that LAA closure is cost-effective in comparison to warfarin at 7 years post-procedure and to novel oral anticoagulants at 16 years. He added that patient out-of-pocket costs are lower with LAAC closure than with warfarin ($5,084 vs. $10,827 annually).

Ramon Quesada, MD, discussed different challenges that LAA closure can pose. He also agreed with Gafoor’s conclusions, but in terms of quality of life. For patients who want to maintain active lifestyles, he said, LAA closure appears to be preferable. Taking warfarin does not allow patients to be as active, he said.

Stephan Bertog, MD, answered the question, “Will LAA closure change my practice?” with a definitive “yes.”

“A wider range of appendages will be amenable to the Watchman FLX device, and other new devices will be available that may be able to close the niche appendages that currently cannot be closed with the Watchman device,” he said. “Some devices may prove to be equally effective and safe compared to Watchman pending trials.” (He listed the ongoing ACP, Wavecrest II and Lifetech trials as examples.)

OTHER HIGHLIGHTS

A.M. Thirugnanam, MD, presented a case discussing management of carotid artery stenosis in a patient with of Takayasu arteritis, an inflammatory disorder of their arteries, with intravascular lithotripsy (Shockwave).

Andrew Shammas, BS, presented a case involving the use of Venovo venous stent in a pregnant patient with left iliac vein compression.

One particularly interesting session and panel discussion concerned how to set the endpoint for a potential low-risk mitral vjalve repair trial.

Anees Musallam, MD, presented a case of valve infolding in a self-expanding TAVR valve.

COMING SUNDAY

CRT will kick into high gear on Sunday with our first keynote speaker, former Secretary of State John Kerry, the first late-breaking trials and the Women and Heart Symposium. Watch your inbox for more details, and be sure to download the CRT Meetings app on the Apple App Store or Google Play Store.

CRT 2020 – Day 2 Wrap-Up


CRT 2020 kicked into full gear with the Nurses and Technologists course, featuring the Women and Heart Symposium; six live cases; late-breaking trials; and former Secretary of State John Kerry giving the keynote.

LATE-BREAKING TRIALS

The first three late-breaking trials of CRT 2020 were presented Sunday afternoon:

WOMEN AND HEART SYMPOSIUM

An all-women panel took the main arena stage for what has become one of the most popular parts of CRT: discussing the challenges and successes of women in interventional cardiology.

Sheila Sahni, MD, shared about the role of media in her career. She helped start the hashtag #RadialFirst on Twitter to share evidence concerning radial access. In 2019, she agreed to take part in a television show called Chasing the Cure with former Today show host Ann Curry. It depicted cases and invited viewers participate in “crowdsourcing” diagnoses. Sahni said she scrutinized every one of her lines and made sure her image upheld and reflected the high standards of the interventional cardiology profession, and she emphasized that any clinician considering being a regular media presence should keep in mind the image they project.

Roxana Mehran, MD, spoke of the importance of publishing research. To more effectively do that, she said it is important for interventional cardiologists to get master’s degrees in subjects such as biostatistics, in addition to their medical degrees.

“The future is very, very strong for women,” Mehran said, adding that any woman who becomes an interventional cardiologist shows that she is serious and resilient. “The way to now separate yourself from the rest of the pack, from the guys, is to do really great research.”

Alin Gragossian, DO, MPH, an emergency medicine resident at UPMC Pinnacle Health System in Harrisburg, Pennsylvania, gave the keynote speech, “A Change of Heart.” She said that during her residency at Hahnemann University Hospital in Philadelphia, she developed a cough and eventually became progressively more tired and was not sleeping well. Her symptoms got so bad that she went to the emergency room and, while there, she went into cardiogenic shock and developed heart failure, with an ejection fraction that had dropped to 5%. She got a heart transplant and is thriving today, ready to start a fellowship at Mount Sinai Hospital.

This experience prompted Gragossian to become an advocate for organ donation. She also started a blog, A Change of Heart (https://www.achangeofhe.art), that quickly drew a large following.

“Young, healthy patients look good until they don’t,” Gragossian said. “Always remember that everything you do matters.”

WOMEN-LED LIVE CASE

Immediately after the Women and Heart Symposium, the Nurses and Technologists course resumed with a women-led live case broadcast from The Heart Hospital Baylor Plano in Plano, Texas. The operators were Molly Szerlip, MD, and Robert Smith, MD, with echocardiography by Zuyue Wang, MD.

Their patient was a 67-year-old man with severe functional mitral regurgitation and ischemic cardiomyopathy with a low ejection fraction (30%). The patient also has profound pulmonary sarcoidosis, and 3-D echo showed a very restricted posterior leaflet.

“Boy, did you not pick an easy case,” panelist Megan Coylewright, MD, MPH, remarked. The operators implanted two MitraClips, an XTR with longer limbs and an NTR with shorter limbs.

By the time the broadcast ended, the operators had successfully implanted the second MitraClip.

“You worked tremendously well together as a team,” said panel moderator J. Dawn Abbott, MD. “Excellent job on this case.”

GREAT DIET DEBATE

A new feature this year was the Great Diet Debate. Nearly every seat was filled in the CRT Innovations HUB. Kim Allan Willams, MD, MACC, and Angela Taylor, MD, MS, moderated. Williams is a well-known vegan cardiologist. Taylor presented evidence advocating for a vegan diet as well, including that sensitization to meat sugar increases plaque vulnerability.

Eugenia Gianos, MD, showed that a healthful plant-based diet does help reduce cardiovascular events, but an unhealthful plant-based diet (i.e., potato chips and other foods high in saturated fat) shows no benefit. Benefits were also shown with the DASH (Dietary Approaches to Stop Hypertension) and vegetarian/vegan diets, she said, but the data collected in those studies do have limitations, such as small sample sizes. She also summarized the PREDIMED study, which showed reduction in cardiovascular events (driven by stroke) for people who followed a Mediterranean-style diet compared with a control group.

Biljana Parapid, MD, PhD, spoke on behalf of plant-based diets and prevention. She highlighted several studies showing that plant-based diets separately showed a decrease in stroke risk, heart failure and cardiovascular risk profiles.

Ethan Weiss, MD, was the lone speaker for the keto diet, a popular low-carb, high-fat diet. He explained the basis for the keto diet, which in part is to transform fat cells into sources of energy, thereby driving weight loss. He cited studies showing that low-carb, high-fat diets demonstrate benefit in weight loss in comparison to low-fat, higher-carb diets. One study showed a 50% loss of insulin on a low-carb diet vs. a low-fat diet.

DISPARITIES: INEQUALITIES IN INTERVENTIONAL CARDIOLOGY AND HEALTHCARE

Like the Women and Heart Symposium, the Disparities symposium has become a CRT staple. Wayne Batchelor, MD, MHS, and Kim Allan Williams, MD, MACC, were once again the co-course directors. Subjects covered included a glimpse inside cardiac catheterization laboratories in the third world, whether access to care has improved in the last year, and the role telemedicine can play in reducing disparities in the treatment of acute myocardial infarction (MI) between the developed and developing worlds.

Alexandra Lansky, MD, FSCAI, presented data on why women who experience acute MI have poor outcomes. One factor, Lansky said, is that many women who experience acute MI do not exhibit typical symptoms or show no symptoms at all, and fewer symptoms are associated with higher mortality, she said, quoting a published study. Another thing to consider, she said, is that while women overall have roughly equal mortality rates to men from acute MI, women lose larger percentages of their lifespan to the disease because they have longer life expectancies than men.

Anita Krueger, MD, reported on the sparsity of women in the field: less than 5% of interventional cardiologists and less than 7% of cardiothoracic surgeons are female. This is despite the fact that 1 in 3 women die from heart disease.

Swati Mukherjee, MD, discussed gender-specific issues in coronary artery disease. She cited a recently published study showing that only one-third of revascularization patients (either with percutaneous coronary intervention or coronary artery bypass grafting) are women, and that the percentage has fallen over time. Another study shows that door-to-balloon time is more than 10 minutes longer for women than for men, and women are less likely to receive evidence-based treatment than men.

CAREER ADVICE FOR FELLOWS

One of the morning symposia was “Negotiating Fellowships: Life During, Life After.” A panel of interventional cardiologists and an associate professor who teaches investment and corporate finance courses offered career advice to fellows looking to make the next step after their fellowships.

Hayder Hashim, MD, pointed out that young physicians do not necessarily understand the business side because of their focus on education and training for so many years. Some things to look for when searching for a job, he said, include location, whether the job is full- or part-time, whether it is academic or private practice, salary range, and whether it is general cardiology or a combination with interventional cardiology.

He added that it is important to network, such as by attending conferences like CRT and joining societies such as the American College of Cardiology or Society for Coronary Angiography and Intervention.

All of the panelists encouraged fellows not to rely only on job postings but to proactively contact people they know (from working in prior internships, residencies or fellowships) and asking if there are, or will be, openings. They all agreed that often, by the time a job is posted, it has already been filled.

Alexander Truesell, MD, added that #CardioTwitter is a great place to network, even if you do not post frequently.

Yuval Bar-Or, PhD, who teaches finance at Johns Hopkins University, said it is never too early to think about long-term investments for retirement.

LIFETIME ACHIEVEMENT AWARD

Augusto D. Pichard, MD, received the CRT 2020 Lifetime Achievement Award in a brief ceremony before former U.S. Secretary of State John Kerry’s keynote on Sunday evening. Lowell F. Satler, MD, the director of the Cardiac Catheterization Laboratory at MedStar Washington Hospital Center, paid tribute to Pichard, whom Satler called a close personal friend in addition to being a great interventional cardiologist.

“Your milestones have been at the forefront of interventional cardiology, as all of you know, in PCI, coronary imaging and, now, structural heart disease,” Satler said. “Your thought-provoking questions and challenges help stimulate next-generation interventional cardiologists, many of whose careers were propelled by studying your talent in the cath lab as well as understanding the respect and sincere kindness you have for your patients, their families and your colleagues.”

Pichard, former director of the MedStar Washington Hospital Center cath lab and currently medical director at Abbott Structural Heart, said he was surprised by the award, and he appreciated the recognition.

“I thank God for leading me to this moment,” he said, thanking his colleagues for helping him get where is today.

KEYNOTE: JOHN KERRY

The first of CRT 2020’s keynote speakers took the main arena stage Sunday evening. John Kerry, U.S. Secretary of State from 2013 to 2017, addressed a range of issues during his speech and subsequent question-and-answer with CRT 2020 Course Chairman Ron Waksman, MD.

Kerry explained his thinking behind the saying that is the title of his memoir, Every Day Is Extra. It was a mantra for Kerry and his fellow sailors who served in the Vietnam War and returned to the U.S. He compared it to the feeling of patients who survive a medical scare.

“To us, ‘every day is extra’ was not just a statement of fact, which it is – you wake up tomorrow, it’s an extra day,” he said. “But it was an attitude. It was an expression about an attitude about life. It was the recognition of a gift and a mystery: Why me? Why did I get back?”

He spent much time defending the nuclear nonproliferation agreement between the U.S., U.K., Russia, France, China, Germany and Iran.

Waksman asked where Kerry drew the stamina to engage in the prolonged negotiations that forged that agreement. Kerry’s answer drew applause.

“It comes from this: it comes from having fought in a war that we shouldn’t have fought in and knowing that war is the failure of diplomacy,” Kerry said.

CRT 2020 – Day 3 Wrap-Up


The third day of CRT 2020 was action-packed, and former First Lady Michelle Obama capped it off with a warmly received keynote. Here are Monday’s highlights.

LATE-BREAKING TRIALS

The first three late-breaking trials of CRT 2020 were presented Sunday afternoon:

BEST INNOVATIONS COMPETITION

CRT 2020’s Innovations Hub culminated with the Best Innovations Competition on Monday. Steven J. Yakubov, MD, FACC, MSCAI, of OhioHealth Riverside Methodist Hospital in Columbus, Ohio, won for his presentation, “Foldax Tria: First in Human Implant of a Totally Synthetic Polymeric Aortic Valve.”

The “truly next-generation” valve, as Yakubov called it, so far has been used in first-in-human surgical aortic valve replacement (SAVR) procedures, but Yakubov said it is under development for use in transcatheter aortic valve replacement (TAVR) as well.

The TAVR design has a self-expanding nitinol frame with supra-annual leaflets, maintains coronary access, and has a 13-mm polymer sealing skirt. Yakubov said the new polymer technology used in the valve is “engineered to potentially last a patient’s lifetime.” It allows for a larger effective orifice area for better hemodynamics and has a lower profile than existing TAVR valves.

The early feasibility study for the SAVR valve is estimated to finish enrollment in March 2020, with a target to begin the investigational device exemption application process by late 2020. Yakubov added that the first-in-human studies for the TAVR valve are tentatively planned for 2021.

“Steve, great job, and congratulations to you and the team,” said Mark A. Turco, MD, medical director aortic and peripheral vascular for Medtronic, in announcing Yakubov as the winner. Others receiving recognition were:

  • First runner-up, Horst Sievert, MD, of CardioVascular Center Frankfurt, Germany, for “The VLAP: The First Wireless, Microcomputer Implant for the Management of Heart Failure Patients”
  • Second runner-up, George Adams, MD, MHS, of Rex Hospital and University of North Carolina at Chapel Hill, for “The GPX Embolic Device: An Easy To Use Novel Liquid Embolic”

DCB TECHNOLOGY SYMPOSIUM

The DCB Technology Symposium presented the latest information on the state of drug-coated balloon (DCB) technology. Jorge F. Saucedo, MD, MBA, gave a presentation on DCB technology in the coronary arteries. He said four companies hope to enter the U.S. market with coronary DCBs. The SeQuent Please ReX (B. Braun) is a paclitaxel-coated balloon that has the CE mark and received the U.S. Food and Drug Administration’s (FDA) breakthrough device designation in August 2019 for treatment of coronary in-stent restenosis (ISR). MagicTouch (Concept Medical) is a sirolimus-coated balloon with CE approval that received FDA breakthrough device designations for treatment of coronary ISR, stenotic lesions of arteriovenous fistulae or arteriovenous graft in hemodialysis treatment of renal failure and treatment of peripheral arterial disease (PAD) below the knee (BTK). Selution SLR (MedAlliance) is a sirolimus-coated balloon that received FDA breakthrough device designations for the treatment of coronary disease and PAD BTK. Virtue (Orchestra BioMed) is a sirolimus-eluting balloon that received FDA breakthrough device designations for the treatment of coronary ISR and PAD BTK.

“We don’t expect any of these products to be commercially approved in the U.S. for at least 3 years,” Saucedo said. “There is not a week or two that goes by in the cath lab that I don’t wish I had a DCB in the coronaries.”

Several speakers alluded to the December 2018 meta-analysis by Katsanos and colleagues that reported higher all-cause mortality in patients undergoing treatment of femoropopliteal disease with paclitaxel-coated devices compared to control groups in 28 randomized controlled trials.

Aloke Finn, MD, who moderated the symposium with Bruno Scheller, MD, said in his opening remarks that if DCB can overcome such signals of potential challenges, it would be a desirable intervention device because of the prospect of leaving nothing behind, as opposed to the metal struts in stents.

OPTIMAL ANTICOAGULATION AND STENTING TECHNOLOGY FOR ACS AND STEMI

This Power Break Symposium covered several topics, including the ISAR REACT 5 study, the Orsiro ultrathin-strut stent (Biotronik), the BIOSTEMI trial, and the role of anticoagulant vs. antiplatelet therapy.

During the panel discussion, CRT 2020 Course Chairman Ron Waksman, MD, asked Thomas Pilgrim, MD, of University of Bern, Switzerland, if he believes that the Orsiro sirolimus-eluting stent is superior to other current-generation drug-eluting stents (DES).

Pilgrim said it was not about what he believed, but he added, “The evidence shows that Orsiro is probably superior and should be the benchmark” against which newer-generation DES should be compared.

Subhash Banerjee, MD, said he believes there is a lower limit for how thin a stent strut can be and maintain stent integrity.

James Hermiller, MD, concluded the session by noting that there is increasing evidence that the ultrathin-strut stent makes a difference at 1-year after PCI and beyond.

KEYNOTE: MICHELLE OBAMA

Former First Lady Michelle Obama was the CRT 2020 Monday evening keynote. Her answers to questions from CRT 2020 Course Chairman Ron Waksman, MD, often elicited applause from the audience, which packed into the Potomac Ballroom in the Gaylord National Convention Center.

One of Obama’s first well-received responses was about her goal of connecting with other people, regardless of where they come from or who they are. She spoke of how, being someone as influential and public as a First Lady, her interactions with people are often sanitized, and she appreciates genuine connection. She spoke of the international tour she gave after the release of her best-selling book, Becoming, and how she arranged for small gatherings to have the chance to communicate with people on a more intimate level.

“What I learned from that event, what I learned from all the events that I’ve done as First Lady – and Barack has said this time and time again – is that we are so much more alike than we give ourselves credit for,” Obama said.

Obama, who was First Lady from 2009 to 2017, while her husband, Barack Obama, was the 44th President of the United States, spoke about raising her two children, Malia and Sasha, in the White House. She talked about the initiatives she led while she was First Lady, including encouraging education of girls and women, fighting childhood obesity. She talked about being a little girl growing up on the South Side of Chicago and becoming a Harvard-educated lawyer and, later, a hospital administrator, before becoming First Lady.

The last question Waksman asked her was about what she hoped her legacy would be. She responded that she and her husband did what they did while they occupied the White House not for themselves but because they thought it was best for the country. They would have been fine; they already were in the top 1% of the country and would have been whether or not Barack Obama was president.

“We picked the country we want to be in,” she said, “and for eight years, our vision was picked, and now there’s another vision. It’s not personal; it’s obviously what the country wants. But that’s what everybody has to think about. Don’t worry about my legacy. We’re fine. The question is, what do we want for the generations that follow?”

CRT 2020 – Day 4 Wrap-Up


CRT 2020 came to a close today, capping off our first year at the Gaylord National Convention Center in National Harbor, Maryland. Here are some highlights from the last day of the conference:

LATE-BREAKING TRIALS

The last three late-breaking trials were presented:

  • Oral anticoagulation is associated with a lower incidence of leaflet thrombosis, but does not appear to be associated with increased bleeding, compared to aspirin alone at 30 days after transcatheter aortic valve replacement (TAVR) in low-surgical-risk patients: 
  • A pooled analysis of prospective trials demonstrates promising long-term survival after transcatheter mitral valve repair (TMVR) with the Carillon Device (Cardiac Dimensions, Kirkland, Washington) for patients with functional mitral regurgitation (FMR): http://www.crtonline.org/news-detail/pooled-analysis-shows-promising-long-term-survival
  • Results from the MARVEL (Manta Registry for Vascular Large-Bore Closure) Prospective Registry demonstrate that the major vascular complication rate associated the Manta large-bore closure device was 4%, which mimics results from the highly selected US IDE Safe MANTA trial: 

SPECIAL PROCEDURES WORKSHOP: TRANSCAVAL AND BASILICA

This morning symposium focused on newer techniques to perform transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve replacement (TMVR).

Jaffar M. Khan, BM BCh, explained the LAMPOON (Laceration of the Anterior Mitral valve leaflet to Prevent LVOT ObstructioN) technique, which involves tearing the existing mitral valve anterior leaflet to avoid left ventricular outflow tract (LVOT) obstruction in high-surgical-risk patients.

Toby Rogers, MD, PhD, discussed the BASILICA (Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction) technique, which involves tearing the original aortic valve leaflet to avoid coronary obstruction in high-risk patients.

Robert J. Lederman, MD, described several cases involving transcaval approach. This is done in patients with unfavorable anatomy. The TAVR valve is delivered through transfemoral approach to the abdominal aorta through the inferior vena cava. Lederman said transcaval access is “mature” and “safe” and that it has been performed more than 1,000 times.

Rogers and Lederman recommended that interventional cardiologists who want to learn how to perform these newer techniques get in-person training, preferably by visiting experienced operators and watching them conduct cases firsthand.

COMPLEX CORONARY LIVE CASE

After discussing a variety of complex coronary issues, such as complete revascularization in ST-elevation myocardial infarction with multivessel disease or how to optimize bifurcation percutaneous coronary intervention, the morning session turned to a live case from MedStar Washington Hospital Center.

The lead operators were Lowell F. Satler, MD, and Itsik Ben-Dor, MD, with Steven A. Goldstein, MD, on echocardiography.

The patient was a 76-year-old woman who presented with worsening lightheadedness and dyspnea and has a medical history of hypertrophic cardiomyopathy, persistent atrial fibrillation and obstructive sleep apnea.

Goldstein said echocardiography showed that the patient had minimal aortic stenosis but significant mitral regurgitation and systolic anterior motion (SAM). Her gradient was dynamic, panelists noted, as she underwent alcohol septal ablation. The third injection of 0.7 cc of alcohol, bringing her total injected to 2.7 cc, brought her gradient down to approximately 10 mmHg (it had been as high as 40 mmHg).

KEYNOTE: MIKE MUSSALLEM

Mike Mussallem, BS Engineering, chairman and CEO of Edwards Lifesciences, gave the keynote address during the FDA Luncheon Symposium on “Healthcare Reform and Its Impact on Innovation.” He emphasized the importance of innovation in healthcare, but he added a cautionary note.

“We need to be cautious – and you might find it surprising coming from me – that we don’t get too carried away in that regard because if we allow patients to get hurt because the bar is low, then we simply set ourselves up for others to get involved and take control,” Mussallem said. “You know what’ll happen. There will be a front-page story, it’ll be followed by congressional action, and we’ll get an aggressive amount of help in terms of changing our risk profile.”

During a panel discussion, Stuart Seides, MD, physician executive director at MedStar Washington Hospital Center, noted that it took more than 15 years for transcatheter aortic valve replacement (TAVR) to be approved in all patient risk profiles. He asked Mussallem how he pitches potential investors on Edwards’ innovations in the mitral valve space.

Mussallem first acknowledged that both mitral and tricuspid stenosis are much more complex than aortic stenosis has proven to be. He said he is “super straight” with investors, that they can expect many years to pass before any new devices are widely adopted but that these devices would have the potential to help many people in the long term.

SEE YOU NEXT YEAR!

That’s a wrap for CRT 2020. We hope you enjoyed the conference and our new, larger venue, the Gaylord National Convention Center. We hope to see you next year back at the Gaylord, from February 27 to March 2, 2021. Until then, keep up with all things CRT at crtonline.org, crtmeeting.org and our social media pages, and watch your inbox for updates.