The APP-lication of Innovation and Technology to Every-day Clinical Practice: A personal Journey

Transcription

1 The APP-lication of Innovation and Technology to Every-day Clinical Practice: A personal Journey Vinayak (Vinnie Bapat), FRCS.CTh Assistant Professor of Surgery Columbia University Medical Center

2 Me in 2007! Traditional Type A One man team

3 TAVR made entry in my life in 2008

4 True Collaboration Triggered Innovation

5 Valve-in-Valve: 2010

6 Valve-in valve Exciting new application of TAVR Life Saving Challenges: Different valves Different manufacturers Dimensions not available in one place Procedural uncertainities

7 Current Issues for Users Surgeons know the valve but do not know how it looks under fluoroscopy Cardiologist do not know designs of valves Surgical valves have distinct designs and fluoroscopic features

8 Old is Gold Stimulus to Collate Missing information

9 Huge task There are at least 30 aortic valves implanted in last two decades There are at least 10 mitral valves implanted today There are 20 different Mitral rings There are 9 different TAVR devices Valve testing between different manufacturers was NOT going to happen

10 True Partnership Edwards Lifesciences: Andy Campbell, Russ Joseph Medtronic Inc: John Hay St. Jude Medical: Joe Alkhatib Sorin: Laura Ghione, Jessica Masotino Boston Scientific: Darrah Colgan, Eva Klusak

11 Physicians Jean Claude Laborde Susheel Kodali Ganesh manoharan Leonard Conradi David Holzhey Mark Monaghan Raj Makkar Hednrik Treede Jorg Kemfert Marco Di Eusanio

12 First Step: Xray Appearance of Surgical valves

13 Each Valve in Unique - Transcatheter Valve

14 Surgical Valve size Label size Stent ID True ID Valve Label size Stent ID Aspire CE Standard Mitroflow Perimount Trifecta True ID True ID = Stent ID- reduction due to leaflet tissue Bapat et al

15 Second Step : Ideal Sizing 3 Types of Valves different True ID Porcine Leaflets Mounted inside Pericardial Leaflets Mounted inside Pericardial Leaflets Mounted outside True ID = Stent ID 2mm True ID = Stent ID 1mm Stent ID = True ID

16 Why use True ID Helps choose correct size TAVI Valve to avoid excess oversizing CE Porcine: size 27 Stent ID - 25 : Sapien 29 and CoreValve 29 True ID 23 : Sapien 26 and CoreValve 26

17 Correct TAVI positioning Neo-annulus Hancock 2 Biocor/Epic Bapat et al Cath Cardiovasc Intervent 2015;85:685-91

18 Ideal Position With Reference to the Neo-annulus = Sewing ring Sapien 15% CoreValve 4mm Bapat et al:

19 For example Deep placement - suboptimal

20 Mosaic Eyelets tip of the frame post

21 Sapien Just below the eyelets CoreValve 4 th Node at level of eyelets Portico 2 nd Node at level of eyelets

22 Modern times Peer review is important for evidence However, Paper publication and charts of information are tedious Simple Solution Call or Vinnie!

23 My Response use to be Send an image of the Valve Dimensions Which size Sapien or CoreValve to use Picture or movie of Ideal deployment Time Consuming and inefficient

24 The only advantage of Teenage children! They think differently

25 Christmas 2012 Idea of App took shape Challenges No idea how to make one No idea of the cost involved and funds IP and related issues Material needed We sat down with a large paper and put down the flow chart and realised that it was an ideal topic!

26 First Step Prepare a presentation (screen flows) Present to 3M 3 Wise Men Martin Leon Mike Mack Martyn Thomas

27 Smartphone App Valve specific information Specific to the make of the valve Specific to the size of that make Provide ideal Sapien or Corevalve size Provide ideal placement guide under fluoro Information will be available at fingertips**

28 Example - 1 Hancock 2 Biocor/Epic SAV Mosaic Perimount Carpentier Edwards Porcine Standard Magna Mitroflow Trifecta Soprano Unknown

29 Mitroflow Sorin Bovine Pericardial leaflets Leaflets sutured outside the stent Markers Sewing ring Sizes

30 23 Mitroflow Stent Internal Diameter 19 True ID 19 Height - 14 Suggested Sapien valve Size 23 Suggested CoreValve size 23

31 Mitroflow Sapien Ideal deployment Possibility of Coronary obstruction as leaflets are sutured out side Link to movie clip

32

33 example Hancock II CE SAV Mosaic Perimount Biocor Magna Mitraflow Trifecta Soprano Unknown

34 Soprano CE Porcine Will have images of different valves Only three are shown for demo Mitroflow

35 Additions Each page will have back and Home links Examples of low and high Complications CT diameters Echo diameters Links to publications Mitral/Tricuspid/Pulmonary

36 App Launched June 2013 Sent by 16 September 2013 Mr Vinayak (Vinnie) Nilkanth Bapat, FRCS, CTh Consultant Cardiothoracic Surgery Guy s and St Thomas Hospital 6th Floor, East Wing St Thomas Hospital Westminster Bridge Road London SE1 7EH Dear Mr Bapat Techno-College Innovation Award 2013 I am delighted to inform you, on behalf of the EACTS New Technology Committee, that you have been awarded this year s Techno-College Innovation Award for your Valve-in-Valve Smartphone/Ipad App. The Award presentation will take place during this year s EACTS Techno-College in Vienna on Saturday 5 October. You are invited to make a short, 10 minute presentation of your innovation just prior to Hugo Vanermen s keynote lecture. Your presentation is currently scheduled to take place from , but please note that this may be subject to change on the day. Volkmar Falk, chair of the New Technology Committee, will provide a short introduction to the Award, highlighting the top three innovations. You will then be introduced as this year s winner and invited to give your presentation. Please accept our congratuations on behalf of EACTS. I look forward to meeting you in Vienna. Should you have any queries in the meantime, please do not hesitate to contact me at the EACTS Executive Secretariat office, details as above. Yours sincerely Sharon Pidgeon EACTS Executive Secretariat

37 We also had fun Logo

38 We also had fun Color scheme for the App Digital diagrams App testing Primary Aim: Educational App to simplify a complex technique and share information without bias BRC St Thomas Hospital, London : First funding $8000

39 Important Fall outs Keep the App free Increased understanding of issues and solutions Influencing future valve designs Publications and Presentations (over 100, school students, medical students and residents) Development of Mitral App

40 Google Market App store Downloaded in 110 countries More than 30,000 downloads Updates every year Future updates will be every 3 months Inclusion of new techniques Step-by-step Bailouts LAMPOON Valve Cracking

41 Image of a Modern SURGEON Thank you