Interventional cardiology may be backed by 30 years of history, but this dynamic medical specialty is all about the future. At the 30th Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI), May 9 – 12, 2007, in Orlando, FL, a special symposium entitled Therapies in Evolution will highlight pioneering techniques that are propelling percutaneous, or catheter-based, interventions at amazing speed.
“These therapies are in their infancy,” said Ted Feldman, M.D., FSCAI, director of the cardiac catheterization laboratory at Evanston Hospital and a professor of medicine at Northwestern University Medical School in Chicago. “There is more to learn about them month-to-month than in many other areas of medicine year-to-year.”
Take, for example, aortic valve replacement, a procedure that ordinarily involves opening the chest and cutting into the heart or aorta-a surgical procedure some patients are not healthy enough to withstand. Now, using percutaneous techniques, interventional cardiologists can thread a catheter into the narrowed aortic valve opening, inflate a balloon, and expand a stent that has been coupled to a biologic tissue valve. The stent pushes aside the diseased natural valve leaflets, and the new leaflets begin to function in their place.
“It’s an exciting time,” said John G. Webb, M.D., FSCAI, who has performed more than 100 percutaneous aortic valve replacements and is director of interventional cardiology at St. Paul’s Hospital in Vancouver, British Columbia, Canada. “Techniques and devices are progressing rapidly. We’ve learned a great deal in a short period of time.”
Equally impressive are advances in percutaneous repair of the mitral valve, which serves as the portal between the left atrium and the left ventricle. The mitral valve can become leaky as a result of either misshapen valve leaflets at birth or enlargement of the heart during heart failure, which stretches the valve opening and prevents the leaflets from fitting together tightly.
Until recently, major surgery was the only way to reshape the mitral valve. Interventional cardiologists are now testing catheter-delivered devices that improve mitral valve function, either by clipping the tips of the mitral leaflets together, or by surrounding and putting tension on the valve opening, gradually reducing its size.
“This is an overwhelmingly exciting field,” said Dr. Feldman. “It’s just the beginning-and the first step is always the tallest-but we anticipate percutaneous mitral valve repair will offer an alternative for many patients who don’t otherwise have one.”
The Therapies in Evolution session will also delve into catheter-based techniques for regenerating scarred areas of the heart using stem cells. This procedure is performed using a 3-dimensional electromechanical mapping system and a catheter-mounted needle to inject into the heart millions of stem cells that have been taken from the patient’s leg muscle and cultured in the laboratory. Recent studies have shown that stem cell therapy not only markedly improves symptoms in patients with heart failure but also halts enlargement of the heart.
Also on the docket is intriguing evidence that catheter closure of a hole in the heart may bring relief from migraine headaches for some patients, and a look back over 30 years of evolution in interventional cardiology.
The Therapies in Evolution symposium will take place on Thursday, May 10, 8:30-10 a.m.
Headquartered in Washington, DC, the Society for Cardiovascular Angiography and Interventions is a 3,700-member professional organization representing invasive and interventional cardiologists in 70 nations. SCAI’s mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI’s annual meeting has become the leading venue for education, discussion, and debate about the latest developments in this dynamic medical specialty.