Oklahoma Heart Institute cardiologists attend the largest educational conference for interventional cardiology in the world this week at the Transcatheter Cardiovascular Therapeutics Conference in Miami, Fl. The conference is an opportunity for recent trials, studies and reviews of trials to be presented from around the world, alongside live televised cases showcasing the latest in medical advances and cutting-edge technology.
Dr. Wayne Leimbach, Chief of Cardiology at Oklahoma Heart Institute reported on this week’s events on our Facebook page and says the new devices and procedures currently utilized in catheterization procedures in Europe and across the world will greatly improve cardiac care in the United States, once approved by the FDA. “The excitement builds as we see smaller stent valve delivery systems used in Europe, for example, provide fantastic results,” Dr. Leimbach says.
Once such review Dr. Leimbach was interested to attend was that of the RESPECT trial, as well as the similar, but smaller PC trial reviewing the impact of closing a PFO, or hole in the heart, to reduce the risk for recurrent strokes. Although the trials failed to meet their primary endpoints when the data was analyzed based on intention to treat, the RESPECT trial did show a greater than 50 percent reduction in stroke in patients who had the PFO closed versus medical therapy. When the data was analyzed as to what therapy the patient actually got (per protocol analysis), some experts argue the impact of this procedure could be life-changing for people across the world with PFO to prevent strokes.
One in five Americans are born with a PFO, but not all PFO place the patient at the same risk of having strokes. Of all strokes, 83 percent of patients have ischemic stroke and 17 percent have a hemorrhagic stroke. Of the 83 percent of ischemic strokes, only 15 percent are cryptogenic, meaning it cannot be attributed to a specific cause. 40 to 50 percent of patients under the age of 55 with cryptogenic stroke have PFO. Studies show patients with moderate to large shunting or PFO with flopping tissue around the PFO were at increased risk for stroke and show significant reduction in stroke with closure of the PFO. Since these strokes could be debilitating, recurring or even fatal, the RESPECT trial sought to compare the effectiveness of closing the hole in the heart proactively against the results of medical therapy alone.
The review of the RESPECT trial, a randomized clinical trial, found that closing a PFO with the AMPLATZER device reduces the risk for a stroke better than medical therapy alone. Oklahoma Heart Institute currently uses this device for patients with a PFO with moderate to large shunting to reduce their risk for stroke and recurring strokes. Dr. Leimbach supports the review of the trials stating, “This has been consistent with the way we have been treating our patients.”
“For young people cryptogenic strokes could be catastrophic,” Dr. Leimbach adds. “It proves this procedure is safe and reduces preventable strokes.”
Late Breaking Research, TAVR Review and Live Cases
Another notable review presented was that of the COURAGE trial finding revascularization with stenting more effective in reducing symptoms of angina from ischemia than optimal medical therapy. Angina refers to chest pain or discomfort that results when heart muscles do not enough oxygen rich blood.
A standing-room only audience was intent on hearing the latest research on bioabsorbable stents at the conference this year. Original bare are metal stent cause damage to the coronary wall when inserted, however the benefit seen by unblocking the artery outweighed the resulting damage from stenting. In response, researchers created stents coated with drugs to reduce the damage to the arteries, but there were problems with these stents as well. Ultimately, researchers determined the best solution would be to develop stents with a polymer to prevent injury at insertion that would dissolve (in 3 – 6 months), leaving the bare metal stent behind to prevent late stent thrombosis.
Dr. E. Murat Tuzcu, Cleveland Clinic Foundation, presented the findings on the benefits of TAVR, Transcatheter Aortic Valve Replacement. Studies show the clinic benefits for patients with severe aortic stenosis three years following the procedure are sustained. This “continues to support the role of TAVR as the standard of care for symptomatic patients with aortic stenosis who are deemed inoperable,” Dr. Tuzcu says.
Among this week’s full agenda of trial reviews, dozens of live cases were performed in high definition on large television screens. Attendees viewed cases that were presented to TCT as new and emerging technologies, as well as challenging cases. Physicians from across the globe presented their most challenging coronary intervention, endovascular intervention, and structural heart disease cases.