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The Take Home: C3
The 11th annual Complex Cardiovascular Catheter Therapeutics (C3) Advanced Endovascular and Coronary Intervention Global Summit was held in Orlando, Florida, in June. Sharing their thoughts on the meeting with Cardiology Today’s Intervention are Sanjay Misra, MD, FSIR, FAHA, professor of radiology at Mayo Clinic, and Samir R. Kapadia, MD, director of Sones Catheterization Laboratories, head of interventional cardiology and professor of medicine at Cleveland Clinic.
SANJAY MISRA MD, FSIR, FAHA
A unique aspect of this meeting is that it attracts a veritable cross-section of thought leaders from various specialties. Rajesh M. Dave, MD, conference director for C3, goes out of his way to recognize cardiologists, surgeons, radiologists and vascular medicine specialists. Everybody is invested, involved and invited. For me, these are the kind of meetings that are fun to attend.
Meet the Editors
This year, the integration of “Meet the Editors” from the different journals was very exciting: getting an overview of what’s happening in the Journal of Vascular Surgery and the Journal of American College of Cardiology: Interventions. There also was a planned talk from the Journal of Vascular and Interventional Radiology. I thought this new element was exciting and fresh.
Having editors from different multispecialty journals at the same meeting is unique. Usually, these are specialty-specific meetings or specialty-dominant meetings. It was refreshing to have an overview of different journal editors providing the top endovascular topics in their journal for the past year.
Live Cases
Live cases are always a great learning opportunity for the audience. How do you manage the case procedurally? How do you set up the room? What are the technologies you would use? The interaction between the moderators and the person doing the procedure present a variety of opportunities to learn. These may be rather stressful for the proceduralist, but for the rest of us they are valuable, especially when there is a multidisciplinary group of moderators who may do things differently. There are specialty differences and geographic differences in how one would necessarily approach a case.
Technology Forums
Photo credit: C3 Conference 2015; reprinted with permission.
Another session on emerging new technologies in drug elution and their integration with vascular medicine was also exciting. Some of the technology is not yet available in the United States; some is only available in Europe. Having insight into practice changes that are occurring with the adoption of the technology provides a glimpse of where we may be 1 year from now or 5 years from now. It allows us to anticipate trends in clinical practice depending on different hospital settings or practices, and allows you to possibly think about contracts, finances and negotiating with health systems for resources. It depends on how you’re wired, but technology forums give insight into what your practice may look like 5 years from now financially, globally, clinically, educationally and research-wise.
Venous Forum
The venous forum at this year’s meeting was well-received. Venous disease continues to be underrepresented at most meetings, although it is more prevalent than arterial disease. Management, treatment and follow-up of venous disease continues to be a very important issue. Those who are really invested in it can understand how to manage it better. This session provided attendees with a global understanding of managing iliofemoral deep vein thromboses and inferior vena cava occlusions in different varicose veins. The comprehensiveness, breadth and depth of the session was really appreciated.
SAMIR R. KAPADIA MD
One of the most important aspects of a conference is interacting with people. Here, there were a lot of international faculty and thought leaders attending, and plenty of opportunities to talk to them and understand the international perspective, which is critical. It gave the conference a unique flavor.
Implications of Guidelines on Mitral Valve Intervention
During a session, I discussed guidelines for valvular heart disease as related to mitral valve intervention. This is a very important topic because a new guideline from the American College of Cardiology and the American Heart Association came out in 2014. Also, more new devices and technologies are becoming available, most notably the MitraClip (Abbott Vascular), which was approved in fall 2013 and was rolled out to most hospitals in early 2014. Many people are still trying to figure out the role of the MitraClip, when it should be used, and when should we send patients to surgery or manage them medically.
A focus of the talk was how the guideline changed the stages of valvular heart disease. Instead of classifying a patient as symptomatic or asymptomatic, now there is a stage-based clinical presentation. In addition, the guideline changed the definition of severe mitral regurgitation from effective regurgitant orifice (ERO) 0.4 to 0.2. These are huge changes that are difficult for practicing cardiologists to comprehend.
My overall goal was to try to put this in clinical perspective, offer ideas on how to assimilate this information in day-to-day clinical practice, and to highlight important matters of imaging, clinical evaluation and deciding how to properly treat different kinds of patients. Of course, there are areas of uncertainty, and we identified those that require more data or at this point may require a Heart Team or other cautious approach.
How-to Sessions
The how-to sessions on valvular heart disease were also good. Experts highlighted different types of heart valves that are now available and explained how they are deployed and how they differ from each other. Another aspect of the meeting that I enjoyed was the chronic total occlusion-related sessions. They were very informative and had outstanding clinical presentations, including unique case-based analyses.
Disclosure: Misra reports receiving funding from the NIH and serving as chair of the data safety and monitoring board for a trial of FlexStent (Cordis). Kapadia reports no relevant financial disclosures.