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Cardiology Today’s Intervention Editorial Board expounds on top news of 2018, trends for 2019
In 2018, there were a number of thought-provoking developments in cardiac and vascular intervention. Cardiology Today’s Intervention asked members of its Editorial Board to comment on what they thought were the top stories of 2018 and what the interventional cardiology community should be looking forward to in 2019.
Emmanouil S. Brilakis, MD, PhD, Minneapolis Heart Institute
Several innovations are taking place in structural heart disease. PCI is getting more and more complex, with continuous improvements in approaches to such lesions.
David J. Cohen, MD, University of Missouri and Saint Luke’s Mid America Heart Institute
The most interesting and exciting area of interventional cardiology today is in structural heart disease. This excitement reflects both the large unmet need for treating many of these patients who either are too high risk for or do not benefit from traditional cardiac surgery. In addition, the field has had the benefit of some of the strongest evidence to date of the benefit of percutaneous interventional procedures, including transcatheter aortic valve replacement and, more recently, catheter-based mitral valve repair.
Howard C. Herrmann, MD, Hospital of the University of Pennsylvania
I believe that the top trends for 2019 will involve transcatheter therapies for valvular heart disease. I anticipate that MitraClip (Abbott) will play an increasingly important role in the treatment of patients with HF and secondary (functional) mitral regurgitation, that TAVR will show benefit in low-risk patients and its indications will expand and that the first successful transcatheter therapies for tricuspid regurgitation will be investigated.
Michael R. Jaff, DO, Newton-Wellesley Hospital and Harvard Medical School
With the recent publication of a meta-analysis suggesting increased mortality when drug-coated devices are used in patients with symptomatic femoropopliteal artery disease, there is a frenzy of concern about the use of these devices across the world. I anticipate a number of publications in the first quarter of 2019 that will shed more light on this subject, so that the practicing vascular specialist can make an informed decision for their patients.
Morton J. Kern, MD, University of California, Irvine, and VA Long Beach Healthcare System
Structural heart disease interventions are the most exciting news, but incremental advances in PCI with new imaging/physiology techniques, as well as treatment of chronic total occlusions, continue to move the field. Other topics of interest include fractional flow reserve-directed CABG outcomes, innovations to treat tricuspid regurgitation and improved left ventricular support devices.
Lloyd W. Klein, MD, Rush University Medical Center
The failure of nonculprit lesion PCI in cardiogenic shock to improve outcomes was the biggest surprise of the past year. It promises to significantly impact guidelines in shock, but more importantly, it colors how we view nonculprit lesion PCI in STEMI generally. If it is not effective in the sickest patient to save lives, why would it be effective in more elective circumstances? Trends I am monitoring for 2019 include quality of interventional procedures, failure of appropriate use criteria to guide practice and public reporting of PCI outcomes.
Michael J. Mack, MD, Baylor Scott & White Health
If TAVR systems are approved for use in patients at low surgical risk, it will cause a significant impact on treatment of aortic stenosis.
Aravinda Nanjundappa, MD, West Virginia University
The role of medical management for CAD was emphasized in the ORBITA trial. Also of note was the emerging role of fish oil pills for the secondary prevention of cardiac events. Trends to watch in 2019 include alternative access for TAVR, novel bifurcation-dedicated coronary stents and complications of large-bore devices.
Kenneth Rosenfield, MD, MHCDS, Massachusetts General Hospital
The recent furor over paclitaxel-based therapy for PAD, in which a meta-analysis showed a signal of late mortality associated with paclitaxel-coated balloons and stents, has raised concerns that will need to be addressed quickly to better understand any potential downside. These devices are so prominent that this will dominate the airwaves for the first half of the year. Other trends to watch in 2019 include health economics, reimbursement issues and the effects of electronic medical records on practice and outcomes.
Christopher J. White, MD, Ochsner Medical Center
Trends that I will be paying attention to in 2019 include the safety of paclitaxel-coated balloons and stents for treatment of PAD, renal denervation for the treatment of hypertension and congestive HF and the role of interventional cardiologists in stroke intervention.
Disclosures: Brilakis reports he receives consultant/speaker honoraria from Abbott Vascular, American Heart Association, Amgen, Boston Scientific, Cardiovascular Innovations Foundation, Elsevier, GE Healthcare and Medtronic; he receives research support from Osprey; he holds equity in MHI Ventures; and he serves on the board of trustees for the Society for Cardiovascular Angiography and Interventions. Cohen reports he receives research/grant support from Abbott, Boston Scientific and Medtronic and is on the steering committee for the LEADERS FREE II trial. Herrmann reports he received research support from Abbott Vascular, Bayer, Boston Scientific, Corvia, Edwards Lifesciences, Medtronic and St. Jude Medical, and consultant fees from Edwards Lifesciences. Jaff reports he is a consultant for Abbott Vascular, AOPA, Boston Scientific, Cordis, Medtronic, Micell, Primacea, Silk Road Medical, Vactronix, Venarum and Volcano/Philips, and holds equity in Embolitech, Gemini, Janacare, MC10, Northwind Medical, PQ Bypass, Primacea, Sano V and Vascular Therapies. Kern reports he has spoken for Abbott/St. Jude Medical, Acist, CathWorks, HeartFlow, Opsens and Philips/Volcano, and he was a member of the clinical events committee for FAME 2. Klein and White report no relevant financial disclosures. Mack reports he is co-principal investigator of the COAPT trial funded by Abbott, co-principal investigator of the PARTNER 3 trial funded by Edwards Lifesciences and study chair of the APOLLO trial funded by Medtronic. Nanjundappa reports he consults for W.L. Gore and Associates. Rosenfield reports he has financial ties with Abbott Vascular, Access Vascular, Amgen, BIO2 Medical, Capture Vascular, Cardinal Health, Contego Medical, Cook Medical, Cordis, Cruzar Systems, Embolitech, Eximo, Endospan, Icon Interventional, InspireMD, Janacare, MD Insider, Micell Technologies, PQ Bypass, Philips, Primacea, Shockwave Medical, Silk Road Medical, SimSuite, Surmodics and Vortex Medical.