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TCTAP 2023

The MitraClip Shows Promising Results in 5-Year COAPT Trial for Heart Failure Patients

Gregg W. Stone Mount Sinai Healthcare System in New York City, USA Gregg W. Stone, MD (Mount Sinai Healthcare System in New York City, USA), discussed the final 5-year results of the COAPT trial, which examined the effectiveness of the MitraClip in patients with secondary mitral regurgitation (MR) and heart failure on May 8th at TCTAP 2023. Considered the largest randomized trial to date for patients with MR, the COAPT trial involved 614 heart failure patients who were already receiving guideline-directed medical therapy (GDMT). These patients experienced moderate to severe MR, leading to left ventricular dilatation and mitral leaflet tethering caused by papillary muscle displacement. The trial aimed to determine whether addressing the underlying abnormal left ventricle would improve patient outcomes. The participants were randomly assigned to receive either GDMT alone or treatment with the MitraClip. Earlier publications presented the 2-year results, which revealed a substantial reduction of approximately 50% in heart failure hospitalizations (HFH) among patients receiving medical therapy. The recent 5-year results, published in a NEJM, demonstrated a sustained 50% reduction in HFH. Specifically, the patients treated with GDMT alone experienced 447 hospitalizations (approximately two per patient), while those treated with the MitraClip had 314 HFH in 151 patients, resulting in an average reduction from 57% to 33% per year. This marked a statistically significant overall reduction of 47% in hazards. The trial also prioritized safety outcomes, employing a composite measure recommended by the FDA that encompassed device-specific events and progressive heart failure necessitating a heart transplant. The results indicated that within the first year, the measure remained below 12%, achieving a rate of 3.3%. Moreover, only four device-related events (1.4%) occurred in the MitraClip group. The MitraClip procedure is well-known for its safety, and this analysis further substantiated its favorable safety profile. Extending the safety assessment to one year, no abnormal safety events related to the MitraClip, such as device detachment, embolization, endocarditis, severe mitral stenosis requiring surgery, or any other device-related complications, were reported in the MitraClip group. An analysis of the composite outcome of death or HFH demonstrated a significant 47% reduction at the 5-year mark for patients who received the MitraClip in comparison to GDMT alone (Figure 1). Importantly, this reduction remained consistent across all pre-specified subgroups, including age, gender, surgical risk, ventricular size, and other factors analyzed. When examining the time to the first HFH, a Kaplan-Meier analysis revealed a remarkable 51% reduction. Notably, the majority of this reduction occurred within the first three years, after which no significant differences were observed between the two groups. Regarding all-cause mortality, the trial demonstrated a notable absolute reduction of 10% and a relative reduction of 28% over the 5-year duration. However, a landmark analysis unveiled that the mortality reduction was primarily observed within the first two years, with minimal differences between years two and five. This observation could be attributed to the crossover permitted in the trial, whereby patients in the control group who survived for two years and still exhibited severe MR became eligible for treatment with the MitraClip. He explained, “I think that's a really important secondary implication of this study. Waiting until the patients have been observed for several years is futile because a lot of them are going to die every single year. You can prevent a lot of those deaths and reduce HFH by identifying appropriate patients for the MitraClip treatment despite optimal GDMT as soon as possible.” In conclusion, the 5-year results of the COAPT trial provided promising evidence regarding the efficacy of the MitraClip in heart failure patients with secondary MR. The findings demonstrate that transcatheter edge-to-edge repair with the MitraClip is safe. Figure 1. Death or HFH after crossovers Hot Topics Mitral & Tricuspid Valve Therapy Monday, May 8, 11:10 AM - 12:20 AM Valve & Endovascular Theater, Vista 1, B2 CHECK THE SESSION

June 13, 2023 4342

TCTAP 2023

Optimal MSA for LM Crush Technique: New Criteria Any Difference in Any 2 Stent Technique?

Jung-Min Ahn Asan Medical Center, Republic of Korea Jung-Min Ahn, MD, PhD (Asan Medical Center, Korea), showed the relationship between Left Anterior Descending (LAD) and Left Circumflex (LCX) depending on new criteria describing how to optimize two stents for Left-Main (LM) bifurcation stenting technique. For the bifurcation lesion of left main coronary artery disease (LMCAD), a simple crossover of the LM to LAD artery has been considered as a default strategy. “However, there are many cases we cannot avoid two-stenting at bifurcation lesions,” he said . Actually, in many trials about LMCAD including the PRECOMBAT, EXCEL, and NOBLE trials, more than one-third to up to half of patients received the two-stent technique (Figure 1). Even in the EBC-MAIN trial, which favored one-stenting, about 22% of patients in the provisional stenting group received two-stenting (Figure 2). Therefore, we should know how to optimize two stents for LM bifurcation stenting technique to improve the clinical outcomes of patients with LMCAD. Figure 1. Two Stent Technique in rRandomized Trials Figure 2. Randomized Trials for True LM Bifurcation In 2011, Kang et al. reported LM intravascular ultrasound (IVUS) minimal stent area (MSA) criteria based on the result of a total of 403 patients treated with LM percutaneous coronary intervention (PCI) (Figure 3). However, the previous study included a heterogeneous group of patients, and therefore, we needed specific MSA criteria for the LM crush technique based on the long-term follow-up data. Also, the EXCEL and Spain Registry Criteria suggested a bigger MSA compared with the LM IVUS MSA criteria. Figure 3. LM IVUS MSA criteria “So, we needed new MSA criteria for the LM crush technique,” he said (Figure 4). Figure 4. LM IVUS Optimization Criteria “We included a total of 292 patients with unprotected LMCAD treated with crush technique who had completed post-stenting IVUS and analyzed a major adverse cardiovascular event (MACE), a composite of death, myocardial infarction, or repeat revascularization (Figure 5).” Figure 5. Optimal MSA Criteria for LM Crush Technique Based on Long-Term (5-year) Clinical Outcomes “Based on the 5-year MACE outcomes, we determined the best cut-off value to predict the 5-year clinical outcomes,” he said (Figure 6). Figure 6. ROC Curve Analysis “LM did not show any association between LM MSA and MACEs, because LM MSA was large enough not to occur any cardiovascular events (Figure 7, 8). However, the MSA of LAD and LCX was linearly associated with MACEs (Figure 9). So, according to the aforementioned criteria, there was no significant difference in clinical outcomes between LM MSA >11.8 mm2 and LM MSA

June 08, 2023 4413

TCTAP 2023

My Approach to Multi-Vessel Disease Insight from ISCHEMIA Study

Seung-Jung Park Asan Medical Center, Republic of Korea Seung-Jung Park, MD (Asan Medical Center, Korea), sheds light on following consequences: For all ischemic lesions with favorable anatomy for percutaneous coronary intervention (PCI), consider guideline-directed medical therapy with complete revascularization with drug-eluting stent (DES). For unfavorable anatomy for PCI and low ejection fraction (EF), and/or diabetic patients, consider optimal medical treatment with coronary artery bypass grafting (CABG) first. Further studies on physiology and image-supported contemporary PCI versus CABG in multi-vessel disease (MVD) patients with ischemic cardiomyopathy (EF

June 08, 2023 2115

TCTAP 2023

TAVR Techniques in Bicuspid Anatomy - Valve Selection, Sizing, and Positioning

Jung-Min Ahn Asan Medical Center, Republic of Korea TAVR Technique in Bicuspid Anatomy, Jung-Min Ahn, MD, PhD (Asan Medical Center, Korea), stressed not to do oversizing in bicuspid aortic valves (BAV) patients using the self-expandable valves (SEV). “For BAV trans-catheter aortic valve replacement (TAVR), undersizing is safe and effective when considering calcification and annulus shape.” he said. He explained how to determine sizing in BAV TAVR according to the amount of calcification and its risk of rupture at the 28th TCTAP 2023 on May 7. In the previous STS/ACC TVT Registry, using Sapien 3 valve, BAVs and tricuspid aortic valves (TAVs) were not found to be different in terms of 1-year mortality or stroke, and Evolut R had no different outcomes for all-cause mortality. Recent registry data comparing the Sapien XT and CoreValve devices showed no difference in all-cause mortality after 2 years of follow-up. Additionally, the BEAT registry found no difference in mortality between the Sapien 3 and Evolut R devices, but the former was associated with a higher risk of annulus rupture, while the latter was associated with significant paravalvular leakage (PVL). He pointed to the BAVARD registry (Figure 1). It was found that about 90% of BAVs were of the tubular or flare type, which required annulus sizing without consideration above the annulus. Severe aortic valve calcifications, such as severe asymmetric calcification, calcified raphe, and left ventricular outflow tract (LVOT) calcification, are also associated with higher procedural risk and long-term mortality, and the optimal device sizing should be adjusted for the calcification volume. Figure 1.Sizing of BAV TAVR by the BABARD registry According to him, undersizing rather than oversizing is safe and effective in treating bicuspid aortic stenosis. He cited their Sapien 3 registry findings, which showed that compared to TAVs with 110% oversizing, BAVs required only about 105% oversizing during TAVR (Figure 2). Figure 2.Comparison of BAV and TAV oversizing from the Sapien 3 registry He stated the following conclusion as below (Figure 3). Figure 3. Optimal TAVR by BEV for BAV Hot Topics NEW TAVR Sunday, May 7, 5:30 PM ~ 6:30 PM Valve & Endovascular Theater, Vista 1, B2 CHECK THE SESSION

May 30, 2023 2292

TCTAP 2023

Contemporary Trends in Aortic Stenosis Management - Legend's Perspective

Martin Bert Leon Columbia University Irving Medical Center, USA Aortic stenosis (AS) should be thought of as a lifelong journey disease, and previous traditional notions of AS should be modernized and altered. Martin Leon, MD (Columbia University Irving Medical Center, USA), opened the 28th TCTAP 2023 with a Keynote lecture that discussed the contemporary trends in AS management. He emphasized that AS should be thought of as a lifelong journey disease, not just focusing on the index procedure itself, but the upstream and downstream development for this therapy is critical. Prior to the index procedure, new diagnostic methods have been developed, including an electrocardiogram (ECG) algorithm using artificial intelligence (AI) machine learning, which has shown high sensitivity and specificity in diagnosing left-sided valve diseases “We also believe that upstream thinking requires an understanding that our previous traditional notions of AS should be modernized and should be altered.” He stressed the importance of understanding the patient's lifelong journey upstream, and how our traditional notions of AS should be modernized and altered. He argued that in addition to the traditional concepts of AS severity, it is necessary to subdivide severe AS according to the degree of cardiac damage and that even if asymptomatic, the prognosis varies depending on the cardiac damage (Figure 1). Figure 1. Staging classification in severe AS He also introduced the conceptual framework of upstream AS treatment, which aims to delay disease progression and shift clinical research efforts from late-stage reactive aortic valve replacement (AVR) to early-stage preemptive AVR and other complementary therapy approaches. He discussed several clinical trials looking at earlier management and follow-up for AS, including surgical trials and transcatheter studies. He suggested the upstream treatment not only for patients with asymptomatic severe AS but also for patients with at-risk predictors in moderate AS (Figure 2). Figure 2. The framework of upstream AS treatment “Now after the index procedure, we need to be also concerned about downstream considerations, particularly AV valve durability and adjunct to pharmacotherapy.” He also explained the importance of downstream considerations, such as AV valve durability and adjunct pharmacotherapy. Although the incidence rate of bioprosthetic valve failure is not high, it does occur, so new materials to overcome it have been introduced. “We believe that these trials (e.g., pharmacotherapies for AS) have been delayed but are now beginning to resurface with many new potential therapeutic targets and exciting new clinical trial methodologies.” Although the pharmacotherapies that slow down the progression of AS have not yet been discovered, efforts are being made to develop new drug treatment methods through the improvement of new treatment targets or research methods (Figure 3). Figure 3. Treatment strategy by AS severity grading and cardiac staging Finally, the lecture ended with him saying that the treatment of AS is a lifelong journey that requires treatment from various perspectives and aspects, such as earlier diagnosis, preemptive treatment, improvement of valve durability, and improvement of pharmacotherapy. Opening of TCTAP 2023 & Keynote Lectures Sunday, May 7, 9:30 AM - 10:16 AM Main Arena, Walker Hall, Level 1 CHECK THE SESSION

May 30, 2023 3221

TCTAP 2023

Catheter-Based Strategies to Treat Tricuspid Valve Disease

James Flaherty Northwestern University / Bluhm Cardiovascular Institute, Northwestern Medicine, USA During the Hot Topics session on May 8th at TCTAP 2023, James Flaherty, MD (Northwestern University Feinberg School of Medicine, USA), shared the broad overview and updated catheter-based strategies for tricuspid valve regurgitation. Functional tricuspid regurgitation (TR) is a progressive disease with a time interval of 5±3 years from mild to moderate/severe regurgitation. If left untreated, it can lead to the enlargement of the right atrium and ventricle, as well as the development of heart failure. One year survival rate with severe TR reaches up to 64%. Historically, isolated tricuspid valve operations had rarely been performed due to high operative mortality (9%) and morbidity (42%) based on the STS database. To overcome the limitation of surgical treatment, several options of transcatheter-based approaches have been tested over the last decades (Figure 1). Figure 1. Transcatheter tricuspid landscape First, transcatheter edge-to-edge repair (TEER) for TR The TRILUMINATE was a pivotal trial evaluating the safety and effectiveness of a transcatheter tricuspid valve repair system, the TriClip device, for the treatment of moderate-to-severe TR. It showed an adequate reduction of less than moderate TR, correlated with symptomatic improvement compared to medical therapy alone (KCCQ +12.3% vs. +0.6% at 30 days after the procedure). The PASTE trial tested the PASCAL transcatheter valve repair system showing similar results, TR reduction and symptomatic improvement. Second, the transcatheter tricuspid valve replacement (TTVR) system (EVOQUE device) The EVOQUE system is designed to replace the patient’s native tricuspid valve with a prosthetic valve that is inserted using a catheter. The TRISCEND trial and global registry showed a high implant success rate of 96.2%, the survival rate of 90.1%, and significant and sustained TR reduction with 97.6% of patients with mild or trace TR at 1 year. Third, annuloplasty The Edwards Cardioband Tricuspid Valve Reconstruction System Early Feasibility study enrolled 37 patients who had severe functional TR with NYHA class III/IV (65%). There was a progressive reduction of TR, from 44% of less than moderate TR at 30 days to 75% at 1 year. Lastly, he pointed out several unanswered questions about transcatheter tricuspid valve therapies, including the appropriate timing for intervention, device durability, and anti-coagulation after TTVR. Hot Topics Mitral & Tricuspid Valve Therapy Monday, May 8, 11:10 AM - 12:20 AM Valve & Endovascular Theater, Vista 1, B2 CHECK THE SESSION

May 24, 2023 1957

TCTAP 2023

Insight from All Data of Left Main Revascularization (MAINCOMPARE, SYNTAX, PRECOMBAT, NOBLE, EXCEL)

Duk-Woo Park Asan Medical Center, Korea (Republic of) At TCTAP 2023, Duk-Woo Park, MD, PhD (Asan Medical Center, Korea), shared insights from the MAINCOMPARE, SYNTAX, PRECOMBAT, NOBLE, and EXCEL trials and emphasized the importance of discussing the potential benefits, advantages, and disadvantages of the procedures with the cardiac surgeon. In the past two decades, several trials have been conducted to study left main and multi-vessel disease, including the SYNTAX, PRECOMBAT, EXCEL, and NOBLE trials. These trials have shown significant progress in both percutaneous coronary intervention (PCI) and bypass surgery for these conditions. While the surgery was consistently shown to be better for multi-vessel disease, there were differences in primary endpoints for left main disease among the trials. The Asan team conducted several registries and clinical trials, including the MAIN-COMPARE registry in NEJM, the PRECOMBAT for left main, and the BEST for multi-vessel disease. Recently, the team performed a 10-year follow-up on the PRECOMBAT trial, which showed no statistical difference in the primary endpoint but did reveal a difference in ischemic-driven target vessel revascularization (TVR). The controversy surrounding left main and bypass surgery is related to the EXCEL trial, where a mortality difference was observed but the primary endpoint of up to five years had some crossover with no statistical difference. An individual participant data (IPD) meta-analysis was conducted and published in the Lancet journal, which showed no difference in overall mortality between PCI and coronary artery bypass graft surgery (CABG) up to 5 years and up to 10 years in the SYNTAX and PRECOMBAT trials (Figure 1). Figure 1. Summarized of IPD meta-analysis of PCI versus CABG in left main coronary artery disease (LM CAD) The updated ACC guideline recommends bypass surgery for left main disease as a Class I recommendation, while PCI could be optional and is a Class IIa recommendation. The ESC has not yet updated its guidelines, which still recommends bypass surgery as a consistent Class I and PCI as a Class I, IIA, or III according to the SYNTAX category. There are still unmet needs, such as no further clinical trial comparing PCI and bypass surgery for left main being planned. The definition of myocardial infarction (MI) is still controversial, and complete and incomplete revascularization, the role of intravascular ultrasound (IVUS) and fractional flow reserve (FFR) in left main revascularization, and all-cause mortality versus cardiac mortality still require adjudication. Long-term follow-up data of big trials beyond five years up to 10 years is absolutely required, and the SYNTAX score is still questionable. One major issue is how to equalize left main PCI technique, as data shows that left main PCI procedures only make up 1.0% of all procedures in the United States over time in daily practice, which indicates a need for more operator training. The latest development in state-of-the-art PCI is the incorporation of imaging and physiology. This involves the use of IVUS and FFR, which play important roles in improving the outcomes of PCI. The future of PCI for left main disease could involve adopting this imaging and physiologic concept (Figure 2). Figure 2. Key component of state-of-the-art left main PCI with imaging and physiologic concept Hot Topics Left Main & Multi-Vessel (Concept Changes After ISCHEMIA) Sunday, May 7, 3:54 PM - 4:10 PM Presentation Theater 1, Vista 3, B2 CHECK THE SESSION

May 24, 2023 1826

TCTAP 2023

P2Y12 Inhibitor or Asprin for Long-term Antiplatelet Management

Kyung Woo Park Seoul National University Hospital, Korea (Republic of) Kyung Woo Park, MD, PhD (Seoul National University Hospital, Korea), introduced the latest evidence on long-term antiplatelet management, including their HOST-EXAM trial at TCTAP 2023 on May 7th. Antiplatelet therapy is the mainstay of treatment to reduce the ischemic risk in patients undergoing percutaneous coronary intervention (PCI). The current guidelines recommend life-long single antiplatelet therapy (usually aspirin as the first-line treatment) following a period of dual antiplatelet therapy (DAPT). However, this recommendation was not based on a large, randomized trial. Therefore, the comparative efficacy and safety of monotherapy with a P2Y12 inhibitor or aspirin after a due duration of DAPT still remains incompletely understood in post-PCI patients. In the HOST-EXAM trial, patients undergoing PCI with a drug-eluting stent who completed 6-18 months of DAPT without any ischemic or major bleeding complications were randomized to monotherapy with clopidogrel or aspirin. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction (MI), stroke, readmission due to acute coronary syndrome, and bleeding academic research consortium (BARC) type ≥3 bleeding. At 24 months, the use of clopidogrel was associated with a 27% relative reduction in risk of the primary composite endpoint. The benefit of clopidogrel was also observed for the thrombotic composite outcomes as well as any bleeding. “In the HOST-EXAM Extended study, we extended follow-up of these patients up to median 5.8 years after initial randomization,” he mentioned (Figure 2). Figure 1. Study flow of the HOST-EXAM Extended study. In the HOST-EXAM Extended study, the composite primary endpoint occurred in 12.8% of the clopidogrel group compared to 16.9% of the aspirin group at a median follow-up of 5.8 years. (HR 0.74; 95% CI 0.63-0.86; p

May 24, 2023 1860

TCTAP 2023

State-of-the-Art Technique for Transcatheter Closure of Paravalvular Leaks

Wojciech Wojakowski Medical University of Silesia in Katowice, Poland Renowned cardiologist, Wojciech Wojakowski, MD (Medical University of Silesia in Katowice, Poland), sheds light on technical considerations and execution of the transcatheter paravalvular leak (TPVL) procedure during a recent medical conference. Paravalvular leaks (PVLs) are serious complications that can occur after surgical valve replacement or transcatheter aortic valve replacement (AVR). TPVL closure offers a less invasive alternative to surgical re-intervention. The safety and feasibility of TPVL closure have been validated through several registries and a meta-analysis. He shared valuable insights regarding technical considerations and recommendations for the TPVL procedure on May 8th, 2023, at the TCTAP conference. "PVL occurs due to various factors such as the type of prosthesis and endocarditis," he explained. "The overall incidence of PVLs ranges from 5% to 18%, with 74% occurring within the first-year post-operation and 16% appearing later due to suture dehiscence associated with subacute bacterial endocarditis." Indications for TPVL Closure He emphasized that TPVL is contraindicated in the presence of valve rocking/instability or active infective endocarditis. However, the procedure can be performed when heart failure symptoms (NYHA II-IV class) and/or hemolysis are present, along with a PVL jet of Grade 2 or higher observed in color Doppler (color coded Doppler flow mapping) on echocardiography. Additionally, specific parameters related to the valves need to be identified. For mitral PVL, these parameters include systolic flow reversal in the pulmonary vein, increased pulmonary artery pressure, lack of left atrium (LA) size reduction, or progressive LA dilatation after mitral valve replacement (MVR), and high forward transprosthetic flow velocity. In the case of aortic PVL, parameters, such as holodiastolic flow reversal in the descending aorta, lack of left ventricle (LV) size reduction, or progressive LV dilatation after AVR, and high forward transprosthetic flow velocity, should be assessed. Diagnosis of PVL When PVL is suspected, an echocardiography study is crucial to confirm the diagnosis. Three-dimensional transesophageal echocardiography (3D-TEE) allows for a better definition of the PVLs, assessing their number, shape, and location, making it the gold standard for PVL evaluation. "For PVL sizing, the cross-sectional area can be measured in 3D-TEE multiplanar reconstruction, using single-beat acquisition only," he added. TEE plays a crucial role during the TPVL closure procedure, and 3D-TEE is essential for device selection, procedure guidance, and result assessment. Additionally, fusion imaging techniques automatically fusing live 3D-TEE and live X-rays in real-time can provide valuable assistance during procedures such as a transseptal puncture or crossing the PVL with the guide wire. Figure 1. Transcatheter Techniques for TPVL Closure When it comes to aortic PVL closure, the retrograde approach is commonly used for most cases, while the anterograde approach with an apical puncture is rarely employed. He explained the "mother-and-child technique" which involves using a diagnostic catheter within a guiding sheath. After crossing the defect, a hydrophilic guidewire is replaced with a stiffer wire, and the device is finally deployed after advancing the delivery sheath. In the case of mitral PVL closure, the anterograde approach with transseptal puncture is mostly utilized, while the retrograde approach with transaortic or transapical puncture is seldom used, particularly for posterior or medial mitral PVL. He emphasized that the location of the septal puncture depends on the PVL's location and should be guided by TEE. In certain instances, such as septal PVL or unfavorable angles between the transseptal puncture and the defect, using a deflectable catheter like the Occlutech steerable guiding sheath can be highly beneficial. Current Device Selection PVLs vary in size and shape, often appearing crescentic and serpiginous rather than cylindrical, making it challenging to find a single device suitable for all cases. The Amplatzer Vascular Plug (AVP) III is widely used and approved for PVL in Europe. The Occlutech Paravalvular Leakage Devices (PLD) have received a CE-marking for PVL. According to him, AVP III lacks sealing materials on both sides of the disc, allowing for oversized use in irregular or crescentic PVL and multiple PVLs (Figure 2). On the other hand, PLD features sealing materials on both sides of the discs, not permitting oversizing and enabling use in round or oval PVL but limited to single PVL cases. Figure 2. Current device selection for PVLs Post-Procedural Assessment and Follow-Up Multiple registries and a meta-analysis have confirmed the safety and feasibility of TPVL closure. However, there is a risk of residual or recurrent leak and hemolysis, and incomplete closure, despite reducing heart failure symptoms, may lead to a worsening of hemolysis. He highlighted factors influencing hemolysis recurrence after TPVL, including the amount of remaining paravalvular leakage (less than 90% of the cross-sectional area), mitral location, and calcification. Post-procedural imaging with TEE is recommended to assess device position and residual regurgitation, utilizing color Doppler imaging and specific parameters such as pulse wave Doppler of the pulmonary vein for mitral PVL. Future Directions He concluded that transcatheter closure of PVL is the preferred treatment for patients with heart failure or hemolytic anemia compared to surgical re-intervention, offering lower procedural morbidity and mortality. However, to further enhance procedural success and outcomes, there is a need for dedicated devices that provide complete sealing.. Meet the Experts over Breakfast Mitral & Tricuspid Valve Intervention Monday, May 8, 7:00 AM - 8:00 AM Valve & Endovascular Theater, Vista 1, B2 CHECK THE SESSION

May 24, 2023 1682

TCTAP 2023

Radiation Management for Complex Percutaneous Coronary Intervention

Gerald Werner Klinikum Darmstadt GmbH, Germany According to Gerald Werner, MD (Klinikum Darmstadt GmbH, Germany), percutaneous coronary intervention (PCI) has become a cornerstone in the management of coronary artery disease (CAD). As the complexity of PCI increases, so do the duration of the procedures and the radiation exposure for both patients and medical staff. This increased radiation exposure can have substantial long-term health effects. Therefore, effective radiation management strategies are necessary to ensure the safety and the effectiveness of complex PCI procedures. It is a fundamental principle of radiation physics that radiation cannot be eliminated, only diminished. Therefore, in the context of PCI procedures, our goal is not to eliminate radiation exposure, but rather to manage and reduce it to the lowest levels that are reasonably achievable. However, a significant challenge lies in the fact that operators are often unaware of the ways to optimize their radiation use. Familiarity with X-ray equipment settings, understanding the readings and their implications, and a keen interest in dose optimization are vital components of effective radiation management. A variety of factors influence the radiation dose in PCI procedures, including the complexity of the lesion, the patient's body weight, and the quality of the X-ray equipment. Complex lesions, for example, can cause the operation to be prolonged, resulting in greater radiation exposure. Patients with a higher body mass, on the other hand, may require a higher radiation dose due to the increased demand for tissue penetration. A mix of modern imaging technology and clever procedural approach is required to address these obstacles and decrease radiation exposure. Recent technological advances, such as newer-generation flat-panel detectors, provide high-quality imaging at substantially lower radiation doses. These technical advances, however, must be accompanied by meticulous procedural planning. The optimization of procedure parameters is a critical component of radiation dose reduction. This involves minimizing fluoroscopy duration, employing the lowest radiation dose possible for image acquisition, and adjusting technical features, such as fluoroscopy frame rates to the unique needs of each patient. Furthermore, measures like appropriate shielding, proper collimation, reducing the angle of C-arm, and saving fluoroscopic images instead of taking other Cine images play an important role in further reducing radiation exposure. There is no doubt that managing radiation exposure in sophisticated PCI procedures is difficult. A solid understanding of radiation physics, on the other hand, can go a long way toward ensuring that radiation is successfully attenuated. Furthermore, ongoing education and training are required to effectively implement these tactics. By implementing these steps, we can ensure that complicated PCI remains a safe and effective treatment choice for CAD patients. Hot Topics Complex PCI - Calcification, Very Long Lesion Monday, May 8, 2:50 PM - 4:00 PM Presentation Theater 1, Vista 3, B2 CHECK THE SESSION

May 18, 2023 2073