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The Take Home: C3
Photo courtesy of C3 Conference
In late June, the 10th annual Complex Cardiovascular Catheter Therapeutics (C3) conference took place in Orlando, Fla., attracting more than 1,100 attendees. The preconference day featured a fellows’ course attended by more than 120 fellows and the nurse/technologist symposium attracted more than 100 attendees.
This year, among other topics, C3 highlighted the latest technological advancements in the field of intervention, including bioabsorbable scaffolds and the developments in aortic and mitral valve therapies, and provided a venue for vigorous debates in how to approach the diagnosis and treatment of CAD. Present at the meeting were Ramesh B. Daggubati, MD, FACC, FSCAI, clinical professor and director of interventional cardiology at East Carolina University, Greenville, N.C., and Parag Doshi, MD, FACC, FSCAI, president of the Chicago Cardiology Institute, who shared with Cardiology Today’s Intervention their take on the standout sessions featured during the 5-day conference.
Ramesh B. Daggubati, MD, FACC, FSCAI
Cases from Around the World
C3 2014 had more than 80 live cases from many different countries, which was remarkable for one meeting. One of the cases that stood out to me was a percutaneous mitral valve repair procedure with the MitraClip (Abbott Vascular). It was performed by Holger Thiele, MD, in Germany and was really outstanding. Usually the procedure takes several hours to complete, but the operators finished it in less than half an hour, demonstrating that with training this procedure can be performed efficiently and successfully.
Ramesh B. Daggubati
Another interesting case was from Sweden and it involved a structural heart intervention of severe aortic stenosis with the Lotus valve (Boston Scientific), a currently investigational transcatheter valve in the United States. This was the first time in the United States that a live case was presented featuring the Lotus valve.
To encourage young practitioners and fellows, several awards were given for best case presentations. One of the winning cases that I found particularly interesting was from Thomas Chengot, MD, from Winthrop University Hospital, Mineola, N.Y. In the case, the Impella hemodynamic support device (Abiomed) was used in patients with aortic stenosis during transcatheter aortic valve replacement. The Impella and TandemHeart (CardiacAssist) technologies, both percutaneous ventricular assist devices, are ones that I use in practice for the management of cardiogenic shock and we have reported that reductions in mortality can be attained by adhering to device protocols.
Pharmacogenomics Highlighted
C3 also provided one of the first venues for a session on pharmacogenomics. This up-and-coming field will likely prove to be increasingly important for interventional cardiologists to understand, particularly as it pertains to drug-to-drug interactions and their role in patient responsiveness to newer medications, particularly the novel oral anticoagulants and antiplatelet agents. The field of pharmacogenomics is very new, so every presentation during that session was really eye-opening.
The Latest on the AUC
Once again this year, Manesh Patel, MD, discussed the appropriate use criteria (AUC). Dr. Patel discussed the new terminology, which has been officially changed from appropriate, uncertain or inappropriate to appropriate, sometimes appropriate or rarely appropriate. I believe these changes will definitely help make the document a little less intimidating for clinicians. It should also encourage more physicians to become familiar with the document and adhere to the criteria, more so than the earlier version.
Novel Interventional Technologies
There was also an excellent session on cardiac arrest hypothermia, which is catching on in the United States. Hypothermia, especially when used in patients who are taken to the cath lab early during cardiac arrest, has been shown to save lives. Currently, it has not been included in the protocol here in the United States, but with increasing evidence coming out of Europe showing benefit with the strategy, we will probably be using it more often in the future.
Other sessions addressed fractional flow reserve and instantaneous wave-free ratio (iFR), as well as chronic total occlusion and endovascular interventions, including critical limb ischemia and the management of venous disease. Currently, iFR is beginning to find more of a home in clinical practice, including ours. We will use iFR first and if the results are in the gray zone, we’ll then administer adenosine and do an FFR. In addition, the CTO sessions, conducted jointly by North American and Japanese colleagues, attracted much attention. This session focused on how to get started in CTO intervention and become familiarized with all the new technology, including re-entry. In time, there will likely be more operators taking on these complex coronary interventions, and these sessions definitely serve an important function in encouraging physicians and educating them on how to perform them efficiently and effectively.
Meet the Legends
And finally, the Meet the Legend session included presentations from great professors, such as Jeffrey Borer, MD; Spencer King III, MD, MACC; Bernard Meier, MD, FACC; Barry Katzen, MD; Juan Parodi, MD; Gary Roubin, MD, PhD; and Mark Wholey, MD. Special mention should be made of Joseph D. Babb, MD, who attended the meeting as well. Their informative talks addressed the changes in management of acute MI during the past decade and how these changes have led to reductions in mortality. One of the great things about C3 was that it provided a great opportunity for young physicians to have a face-to-face chat and reminisce with these founders of interventional cardiology.
Parag Doshi, MD, FACC, FSCAI
Sessions Span Gamut of Intervention
This year at C3, presentations addressed the full scope of the field of interventional cardiology. In the coronary arena, there were sessions on new absorbable stent platforms, with data indicating that the bioabsorbable platform is promising and may one day find a home in the interventionalist’s armamentarium. The sessions on pharmacogenomics, antiplatelet therapy in ACS and newer anticoagulants in atrial fibrillation were presented by expert faculty and attracted a wide array of physician attendees.
Parag Doshi
The peripheral track highlighted drug-eluting technologies, covered stent platforms, re-entry devices and newer stent platforms like the Supera stent (Abbott Vascular). There were also robust sessions on venous insufficiency and venous thrombosis. During the structural heart intervention session, in addition to TAVR, presenters also highlighted left atrial appendage closure devices, in particular the Watchman (Boston Scientific) and Lariat (SentreHeart) devices, and the MitraClip (Abbott Vascular) for mitral regurgitation. Moreover, the expanded use of balloon aortic valvuloplasty with new devices, such as the True balloon (Bard), was discussed. Many of these sessions were presented by principal investigators of the pivotal trials for the devices, which made for really interesting and effective presentations.
Live CTO Cases
The live sessions have always been one of the strengths of C3. We had excellent international live sessions, specifically in the area of CTOs, which is my area of interest. In one case, Simon Walsh, MD, from Ireland, one of the leaders in CTO interventions, demonstrated both retrograde technique and antegrade dissection re-entry using the Stingray device (Boston Scientific). In an international joint collaborative session of the Leipzig Interventional Course (LINC) at C3, a live case of a complex peripheral CTO was performed with discussion on various new techniques for CTO recanalization.
Meet the Legends: Peripheral
Another session I enjoyed was Meet the Legends, which included both coronary and peripheral vascular legends. I particularly appreciated the talks from the peripheral experts, including Dr. Gary Roubin, who is a pioneer in the field of carotid stenting, as well as coronary stenting, and Dr. Barry Katzen, who discussed the development and future of vascular scaffolds. Dr. Juan Parodi, who created the aortic endograft, gave another excellent talk. It was extremely fascinating and powerful to hear from the people who started the field.
In Dr. Parodi’s session, for instance, he discussed how he took a basic device and thought completely out of the box to create the revolutionary aortic endograft, as well as the challenges he needed to overcome to accomplish it. As opposed to creating a device by a very expensive, lengthy process, the first stent graft was just a modification of existing technologies — the graft and the stent. At the same time, it reflects the original thinking of Andreas Gruentzig, MD, who took a catheter and modified and shaped it to create the original angioplasty device.
The Global Evolution
The goal of C3 was to expose the practicing physician to not just the data and new devices, but also to best practices for the management of patients, starting from analyzing the data all the way to the completion of the procedure. Each year, C3 continues to evolve into more of a global platform, which was a huge advantage to attending the meeting.