Conference highlights benefits of robotics, challenges of complex PCI

The San Diego Cardiovascular Interventions course, held in July, included discussions of some of the latest initiatives in PCI, including use of robotic systems to help operators reduce their radiation exposure and the practice of PCI in complex high-risk interventions.

Since complex high-risk interventional procedures (CHIP) often take longer than standard procedures, operators performing them might especially benefit from use of robotic PCI systems, Ehtisham Mahmud, MD, FACC, FSCAI, division chief of cardiovascular medicine and director of interventional cardiology and the cardiac cath lab at University of California, San Diego, School of Medicine, and director of the San Diego Cardiovascular Interventions course, told Cardiology Today’s Intervention.

 

Q: What was the purpose of this event and what you were hoping attendees would learn?

A: This was the second annual meeting of San Diego Cardiovascular Interventions. It’s an annual event and the next meeting will be in July 2017. The purpose of the meeting is to emphasize two broad-based areas within interventional cardiology. One is robotics, and how robotics fit into the future of CV interventions. The second is the concept of CHIP, the complex high-risk interventional procedures.

For 2 days, participants focused on robotics and CHIP, and also the integration of some of these newer CHIPs that are being done, how robotics can be intertwined or interlinked to be able to do these procedures so that there’s improved operator safety, especially when there is prolonged procedure length and risk for extensive radiation exposure for the operator.

We focused on how to integrate robotic technology into the practice of both coronary and vascular interventions. Not just robotics, but all the new technologies that are available to take care of patients who have complex coronary anatomy and are at high risk for surgery as well as angioplasty. 

 

Q: Who was the target audience?

A: The meeting is targeted to internists, cardiologists, interventionalists, nurses and cath lab staff. About half the people who attended were interventional cardiologists or trainees in interventional cardiology, or fellows or cath lab staff. The other half was divided between cardiologists and general internal medicine and nursing staff.

 

Q: What was the format of these teachings?

A: It was a combination of three things: We had didactic lectures in a classroom format in an auditorium; we had live case demonstrations, in which procedures with robotics were performed remotely in a cath lab but transmitted to the meeting space; and we had case-based learning, in which there were prerecorded cases that had key emphasized teaching points. Also, there was simulation training at by industry at their booths that enabled attendees to observe and practice simulated cases.

 

Q: What were some of the key topics covered by the didactic lectures?

A: On the robotics side, we went over the occupational hazards that interventional cardiologists are exposed to, from radiation to orthopedic risks. We also conveyed how to set up a robotics-based interventional program. We covered the technology of robotics, how to utilize them and how one can receive the learning and training that is required. We also covered the data supporting robotic interventions and clinical outcomes for patients.

With respect to high-risk CV procedures, we talked about hemodynamically supported PCI, such as with hemodynamic assistance from Impella products. There was also a discussion of high-risk coronary anatomy, from the left main artery to bifurcation lesions to severe diffused vessel disease to chronic total occlusions. This included updates on various new devices to handle these issues, from atherectomy systems to coronary re-entry devices.

Some lectures addressed surgery vs. percutaneous interventions, reviewing the advantages and disadvantages of each approach.

 

Q: For the cases offered, how were patients selected?

A: Patients were preselected because the meeting was focusing on complicated, high-risk procedures performed robotically. All procedures shown met those criteria.

 

Q: For patients who qualify for CHIP, is it fair to say that until recently they would have automatically been considered for surgery, not for an interventional procedure?

A: Correct. Even now, in most places, surgical treatment is still the first line for these patients, and not necessarily the interventional techniques that have been widely disseminated. We are trying to change this. The key is that the outcomes have to be comparable if not superior, and we now have data to support that. 

 

Q: What was the response from the attendees?

A: A lot of enthusiasm. We started on a Friday morning and went until Saturday evening. My litmus test is how many people are sitting in the audience Saturday afternoon. The room was as packed as it was Friday morning. Nobody left early, and the subsequent objective feedback has been extremely positive as well.

One of the unique things about the event is that it is the only robotic interventional meeting held anywhere in the world, so it’s an opportunity for people not only to get exposed to the technology but to understand the data behind it, how the techniques are performed, and how they can actually use it in their practice. – by Erik Swain

For more information:

Ehtisham Mahmud, MD, FACC, FSCAI, can be reached at Sulpizio Cardiovascular Center, 9434 Medical Center Drive, La Jolla, CA 92037; email: emahmud@ucsd.edu.

For more information about the event, visit www.sdinterventions.com.

Disclosure: Mahmud reports consulting for and receiving research support from Abbott Vascular, Abiomed, Boston Scientific, Corindus and Medtronic.