SCAI. news & highlights. All You Need to Know About Valvular Intervention and More: The SCAI 2017 Structural Track

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1 JANUARY SCAI news & highlights The Society for Cardiovascular Angiography and Interventions All You Need to Know About Valvular Intervention and More: The SCAI 2017 Structural Track No discipline in cardiology has advanced as rapidly as structural heart intervention in the past decade. The focus of the SCAI 2017 Scientific Sessions Structural Track will be to answer the practical questions of how, why and in whom should we proceed with transcatheter therapy for both valvular and non-valvular structural cardiac disease. Transcatheter aortic valve replacement (TAVR) will be emphasized with three sessions devoted to this treatment. Currently approved indications for this technology will be reviewed, James Hermiller, MD, FSCAI SCAI 2017 Structural Track Director including the newly expanded indication for intermediate risk patients. Other challenging patient subsets including valve-in-valve, bicuspid valve, and the patient with coronary disease, mitral repair, or left ventricular dysfunction will be intensively reviewed. Given the rapid uptake of this technology, issues related to effective patient evaluation have come to the forefront and will be discussed, along with reimbursement, during the Outcome Optimization session. Understanding the role of minimally invasive TAVR, its benefits and in whom it should be utilized, will be examined. Finally, we ll look to the future and debate TAVR in patients who are low risk, along with reviewing the latest transcatheter heart valve technologies. Transcatheter mitral valve therapy will be another large focus of the Structural Track. Straightforward and complex transcatheter repair with transcatheter edge-to-edge repair will be reviewed. The valve-in-valve therapies for those patients who have failed mitral repairs or prostheses, and valve in MAC, will also be reviewed. Future treatments such as transcatheter mitral valve replacement will also be discussed. Live structural heart intervention will be one of the highlights of the meeting, including TAVR and transcatheter mitral repair. A special aspect of the track will be shared sessions with the pediatric structural group combining live cases with review of structural heart complications and challenging/best cases. While non-vascular sessions will emphasize left atrial appendage (LAA) isolation, attendees will leave able to identify which patients are approved for LAA isolation, how to evaluate anatomic suitability, and how to perform the procedure and optimize post-implant care. Other therapies discussed will include paravalvular leak closure and management of the hypertrophic cardiomyopathy patient. The track will begin with a Boot Camp where essential structural skills including placement of vascular plugs, complex imaging, transseptal puncture, and hemodynamics are reviewed. As always, there will be more than sufficient time for faculty discussion, which is of particular importance in the structural space. The SCAI 2017 Structural Track is exceptional, and those attending are guaranteed to go home with a treasure chest full of tips and tricks that will improve and expand their practice. IN THIS ISSUE... President s Message...2 Quality News...4 Member News...7 CME Calendar...8

2 PRESIDENT S MESSAGE Dear Members, This past October, we were fortunate to engage many fellow SCAI members in conversations regarding new data presented evaluating the optimal treatment of obstructive left main coronary artery disease (CAD). For our entire careers as physicians, we have been taught that the treatment of left main disease lies almost exclusively within the surgical domain. Today, we now have two well conducted and highly anticipated randomized controlled trials, EXCEL and NOBLE, which rigorously tested coronary artery bypass surgery (CABG) versus percutaneous coronary intervention (PCI). The results, however, were decidedly different between trials and perhaps raise more questions than answers. The EXCEL trial randomized 1905 patients with significant left main CAD (Syntax score 32) to either PCI or CABG. At three years, 15.4% of PCI patients versus 14.7% of CABG KENNETH ROSENFIELD, MD, MHCDS, MSCAI patients experienced the primary composite endpoint of death, stroke, or myocardial infarction (MI), reaching significance for noninferiority of PCI compared to CABG (P=0.018). The NOBLE trial randomized 1201 patients with significant left main CAD to PCI versus CABG. In contrast to its sister trial, after five years of follow up, 29% of PCI patients, versus 19% of patients undergoing CABG, experienced the primary composite outcome of death, non-procedural MI, stroke, and repeat revascularization, thus demonstrating inferiority for PCI (p=0.007) Both trials, although rigorous and well-conducted, are complex in their structure and vary widely in their methodology, how left main disease was defined, and in how revascularization was performed. Given these differences, it may be too early to draw absolute conclusions about whether PCI is definitively equivalent to CABG for all patients with significant left main CAD. Interventional cardiologists, as integral members of the heart team, now possess new and modern data to take to their patients, to engage in a dialogue of which approach best meets each patient s interests. For some, this may mean PCI, whereas, for others, CABG may still be their best solution. SCAI stands by its members, the patients we serve, and our mission to Save and Enhance Lives. We will closely follow further analysis of these data to inform our members of what may be a revolution in the management of CAD, and to better guide our decision-making. We encourage you to join in this ongoing conversation with your fellow members at the SCAI 2017 Scientific Sessions May 10-13, 2017, in New Orleans. Abstract submissions are now being accepted until January 9, Please visit for more information. As always, please contact us at any time with your thoughts and concerns at president@scai.org. Sincerely, Kenneth Rosenfield, MD, MHCDS, MSCAI SCAI President On behalf of your Executive Committee: Peter L. Duffy, MD, MMM, FSCAI President-Elect Kirk N. Garratt, MD, MSc, FSCAI Vice President James C. Blankenship, MD, MHCM, MSCAI Immediate Past President David A. Cox, MD, FSCAI Treasurer 2 SCAI News & Highlights January Ehtisham Mahmud, MD, FSCAI Secretary Chandan Devireddy, MD, FSCAI Chair, SCAI Public Relations Committee SCAI News & Highlights is published by The Society for Cardiovascular Angiography and Interventions th Street, NW, Suite 330 Washington, DC USA Phone ; Fax info@scai.org Kenneth Rosenfield, MD, MHCDS, MSCAI President Peter L. Duffy, MD, MMM, FSCAI President-Elect James C. Blankenship, MD, MHCM, MSCAI Immediate Past President Kirk N. Garratt, MD, MSc, FSCAI Vice President David Cox, MD, FSCAI Treasurer Ethisham Mahmud, MD, FSCAI Secretary John Breinholt III, MD, FSCAI Editor in Chief Jeffrey Schussler, MD, FSCAI Editor in Chief Joan Goldberg Interim Executive Director Trustees J. Dawn Abbott, MD, FSCAI Osvaldo S. Gigliotti, MD, FSCAI Luis A. Guzman, MD, FSCAI Tarek A. Helmy, MD, FSCAI Kalon Ho, MD, MSc, FSCAI Michael R. Jaff, DO, FSCAI Dennis W. Kim, MD, PhD, FSCAI Ayman K.A. Magd, MD, PhD, FSCAI Oscar A. Mendiz, MD, FSCAI Sandeep Mishra, MD, DM, FSCAI Thach N. Nguyen, MD, FSCAI Sunil V. Rao, MD, FSCAI Gerald S. Werner, MD, PhD, FSCAI Trustees for Life Frank J. Hildner, MD, FSCAI William C. Sheldon, MD, FSCAI Staff Kimberly Brown Sr. Associate Director of PR & Communications Eric Grammer Sr. Director, Industry Relations & Global Partnerships Lisa McDonald Vice President, Membership, Marketing, Communications, and Public Relations Wayne Powell Senior Director, Advocacy & Government Relations Bea Reyes Senior Director, Meetings Design and Production Follow SecondsCountOrg

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4 The New Expert Consensus Document on Best Practices in the Cardiac Catheterization Laboratory Is Out! As interventional cardiologists, we spend a considerable amount of time in the cardiac catheterization laboratory (CCL). Over many decades, best practices in the CCL have evolved, as has the complexity of the cases performed there. Various regulatory bodies consider the CCL to be just another operating room (OR) and try to implement OR practices in the CCL. As the official representative body for interventional cardiology, SCAI published an expert consensus document in 2012 on best practices in the CCL. Recently, an update to the consensus document has been published 1 to guide physicians and CCL staff in efficiently managing the workflow in the CCL while ensuring high standards for safety and quality. In the current environment of oversight, this document serves as an excellent resource to minimize omission. Structured fellowship training, careful case selection, and refinement of equipment have reduced the incidence of major complications in CCL. The rarity of complications could result in the physicians and CCL staff being rusty in the management of complications. Emergency drills are a useful way to keep ourselves prepared for such an eventuality. There is a table in the consensus document with suggestions for this periodic exercise. Additionally, these drills are discussed in the September Tip of the Month published on Checklists are the hallmark of the new consensus document! Useful checklists that the physicians and CCL staff can leverage to improve workflow include: 1. Pre-procedure checklist 2. Minimum components of a time-out 3. Components of a well-written cardiac catheterization report 4. Responsibilities of CCL Director 5. Topics for emergency CCL drills 6. How to enhance patient satisfaction 4 SCAI News & Highlights January

5 CONTINUED FROM PAGE 4 Other interesting topics addressed in the new consensus document: 1. Credentialing of CCL and Interventional Cardiologists 2. Hand-washing before each case NOT mandatory! 3. Management of industry presence during cases 4. QA and M&M Conferences 5. Optimization of discharge instructions 6. Random case reviews 7. Hand-off to referring physician This highly utilitarian document represents the efforts of a group of experts in the arena of cath lab quality improvement, is concisely worded yet broadly inclusive topically, and uses guideline recommendations or expert opinion where available. It will be a highly valuable resource to all SCAI-QIT champions going forward. Reference: 1. Naidu SS, Aronow HD, Box LC, et al. SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of India, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Association of interventional cardiology-association canadienne de cardiologie d intervention). Catheter Cardiovasc Interv Sep;88(3): SCAI Publishes Expert Consensus Statement on Anesthesia Sedation Practices for Patients in the Pediatric Congenital Cardiac Cath Lab The Society for Cardiovascular Angiography and Interventions (SCAI), the Society for Pediatric Anesthesia (SPA), and the Congenital Cardiac Anesthesia Society (CCAS), have published recommendations for institutions and physicians diagnosing and treating pediatric patients in the cardiac catheterization laboratory (CCL). This first-of-its-kind document, titled SCAI/CCAS/SPA Expert Consensus Statement for Anesthesia and Sedation Practice: Recommendations for Patients Undergoing Diagnostic and Therapeutic Procedures in the Pediatric and Congenital Cardiac Catheterization Laboratory, was published November 1, 2016, in Catheterization and Cardiovascular Interventions, the official journal of SCAI. Studies concerning anesthesia-related morbidity and mortality have demonstrated that pediatric patients, especially patients with congenital heart disease, are at increased risk for adverse events and even cardiac arrest during surgery. Common complications in children undergoing anesthesia include airway events (laryngospasm, bronchospasm, apnea and aspiration), cardiovascular events (hypotension, arrhythmias and cardiac arrest) and post-operative issues. The consensus statement provides pre-, intra-and post-procedure recommendations for patient monitoring in the pediatric congenital cardiac catheterization laboratory (PCCCL), regardless of whether minimal or no sedation is used, or general anesthesia is provided by an anesthesiologist. Practice regarding the way sedation is administered is highly variable across U.S. hospital systems and institutions, said Robert Vincent, MD, FSCAI, pediatric cardiologist at Children s Healthcare of Atlanta, and the paper s lead author. We developed these recommendations to alert and educate physicians and hospital administrators to the complex and dynamic challenges they may face when treating pediatric patients with congenital heart disease. The document includes: Anesthesia risks in patients with cardiac disease undergoing procedures in the PCCCL Specific cardiac defects with increased anesthetic risks Catheterization and procedural risks in the catheterization laboratory Volume management in patients undergoing catheterization procedures Level of cardiology and anesthesia expertise appropriate for the PCCCL An expert panel representing the three participating societies collaborated with the goal to provide practitioners and institutions performing these procedures with guidance consistent with national standards developed by The Joint Commission and to provide clinicians and institutions with consensusbased recommendations and the supporting references to encourage their application in quality-improvement programs. Visit SCAI's "Clinical Documents & Resources" page and download SCAI/CCAS/ SPA Expert Consensus Statement for Anesthesia and Sedation Practice: Recommendations for Patients Undergoing Diagnostic and Therapeutic Procedures in the Pediatric and Congenital Cardiac Catheterization Laboratory for more information. January 2017 SCAI News & Highlights 5

6 40th Anniversary CELEBRATING THE 40 TH ANNIVERSARY OF SCAI SCIENTIFIC SESSIONS & ANGIOPLASTY ADVANCING CARE TO SAVE & ENHANCE LIVES SCAI 2017 NEW ORLEANS MAY 10-13, 2017 Register Now Robert J. Applegate, MD, MSCAI Program Chair Ehtisham Mahmud, MD, FSCAI Program Co-Chair Sunil V. Rao, MD, FSCAI Program Co-Chair FEATURING: Return of live cases Late-breaking clinical trials Cath Lab Boot Camp track Free On Demand access to all sessions post-meeting with registration Complex Coronary Complications (C3) SUMMIT Chronic Total Occlusion (CTO) and Complete Revascularization of Higher-Risk-Indicated Patients (CHIP) symposium ADVANCE REGISTRATION DISCOUNT ENDS MARCH 31 Online Module Spotlights Professionalism for CV Professionals, Provides MOC Points The American College of Cardiology s (ACC s) free online Medical Professionalism Maintenance of Certification (MOC) module is focused on helping cardiovascular professionals understand and value professionalism. Participants can earn 10 MOC points by answering 30 multiple-choice questions on topics related to medical professionalism, including integrity and accountability, fair and ethical use of health care resources, self-regulation and commitment to excellence. The ACC has offered the professionalism module for adoption by other medical specialty societies and boards. Currently, four organizations have adapted the ACC Professionalism module and have published specialty-specific versions for their members. Additionally, three other organizations are developing adaptations. In each of these cases, the module provides focused commentaries and real-life scenarios on special and practical aspects of professionalism, with the goal of helping inform the next generation of cardiovascular professionals about this important topic. Learn more and preview the module. 6 SCAI News & Highlights January

7 MEMBERSHIP NEWS Recommend Yourself or Colleagues for 2017 SCAI Leadership Positions WHY: Do you care about SCAI s strategic direction? Want to give back to your professional community by serving in SCAI s leadership? Or do you know a qualified individual for SCAI leadership? WHO: SCAI leaders need a commitment to the Society and to its mission of saving and enhancing lives. They should have leadership experience and previous service to SCAI (e.g., on committees, or working groups and/or serving as faculty at SCAI meetings). WHEN: SCAI s Nominating Committee will be meeting this winter to discuss nominees and present a slate of nominees to SCAI members in May 2017 for the following positions: Secretary (traditionally the first step toward becoming SCAI s President) Board of Trustees (multiple openings) Nominating Committee-At-Large Member WHAT: Recommendations should include a description of the individual s: Profile as an interventionalist or cardiovascular professional Leadership ability and experience Service to SCAI (e.g., committees, working groups and serving as faculty at SCAI meetings) The Nominating Committee is chaired by Past President Dr. Blankenship, and includes: Kenneth Rosenfield, MD, MHCDS, MSCAI (President, ) Peter L. Duffy, MD, MMM, FSCAI (President-Elect, ) Kirk N. Garratt, MD, MSc, FSCAI (Vice President, ) The following are At-Large Nominating Committee Members: Luis A. Guzman, MD, FSCAI Oscar A. Mendiz MD, FSCAI Sunil V. Rao, MD, FSCAI J. Dawn Abbott, MD, FSCAI WHERE: All SCAI members will be informed about the recommendations of the Nominating Committee at least 30 days prior to the Annual Business Meeting. The election will take place during SCAI s 2017 Annual Scientific Sessions. Individuals eligible to serve in SCAI leadership positions include those who have completed their fellowship in interventional cardiology and cardiovascular professionals. Recommendations should be sent in the form of an or letter by January 13, 2017 to: SCAI Attn: Wayne Powell th Street, NW, Suite 330 Washington, DC USA wpowell@scai.org Save Our Seat! Your AMA Membership is Important to SCAI, Too! Much of what SCAI achieves for its members and their patients are made possible through SCAI's participation in American Medical Association-led efforts like the CPT panel, which defines what you bill for, and a RVS Update Committee, which influences your allowable charges. It is now time for SCAI to renew its membership in AMA, and 20 percent of SCAI's U.S. membership must also belong to the AMA to retain our position within the House of Medicine. Save our seats and your influence! Activate your 2017 AMA membership today by visiting ama-assn. org/go/join or by calling January 2017 SCAI News & Highlights 7

8 DEPARTMENT DEPARTMENT SCAI program Program cosponsored by SCAI JANUARY 2017 SCAI / SASCI MASTER THE COMPLEX COURSE Date: January 27, 2017 Location: Johannesburg, South Africa FEBRUARY TH ANNUAL INTERNATIONAL SYMPOSIUM ON ENDOVASCULAR THERAPY (ISET) Date: February 4-8, 2017 Location: Hollywood, FL SCRIPPS SIXTH ANNUAL STRUCTURAL HEART INTERVENTION AND IMAGING: A PRACTICAL APPROACH CONFERENCE Date: February 8-10, 2017 Location: La Jolla, CA MARCH 2017 INTERNATIONAL SYMPOSIUM ON LEFT ATRIAL APPENDAGE (ISLAA 2017) Date: March 3-4, 2017 Location: Austin, TX MAY 2017 SCAI 2017 SCIENTIFIC SESSIONS Date: May 10-13, 2017 Location: New Orleans, LA DECEMEBER 2017 SCAI 2017 FALL FELLOWS COURSE Date: December 9-12, 2017 Location: Las Vegas, NV For more information on SCAI-sponsored and co-sponsored events, please visit: ISLAA 2017 Save the Date 4.25x5.5 Ad.pdf 1 11/21/2016 9:51:51 AM C M Y CM MY CY ISLAA th International Symposium on Left Atrial Appendage CMY K March 3-4, 2017 Austin, Texas Sponsored by Co-sponsored by 8 SCAI News & Highlights January