Structural Disease Update
The field of structural intervention is expanding rapidly, with many developments in transcatheter aortic valve replacement (TAVR) and a variety of new approaches and devices under study. This issue contains updates on several structural interventional topics.
First, Akhil Narang, MD, and Amit Pursnani, MD, explain what cardiovascular magnetic resonance has to offer in the field of structural disease therapy and how this imaging modality might be best used. We then dive into techniques for percutaneous left ventricular apical access with Mayra Guerrero, MD; Amit Pursnani, MD; Mike Salinger, MD; Justin Levisay, MD; Paul Pearson, MD; and myself, who discuss the advantages and the risks associated with this approach.
Because paravalvular leak after TAVR remains a major limitation of early generation devices that have been implanted, Satpal S. Arri, BSc, MRCP, and David Hildick-Smith, MD, FRCP, describe the challenges of treating paravalvular leak post-TAVR, how to prevent it from occurring in the first place, and the techniques for treating it when it does happen. Wes Pedersen, MD, and Paul Sorajja, MD, then continue the conversation on TAVR with an overview of the current indications and uses for balloon aortic valvuloplasty, both during TAVR and as a stand-alone technique in unique settings.
Next, Daisuke Kobayashi, MD, and Thomas J. Forbes, MD, review the basis of knowledge we’ve gained over the past 2 decades on balloon angioplasty, stenting, and surgical options for treating coarctation of the aorta in older children and adults.
We then move onto a discussion on left atrial appendage (LAA) closure, in which Jayant Khitha, MD, and Tanvir K. Bajwa, MD, outline the rationale for this procedure to prevent stroke. The authors also review the current data on the Watchman device (Boston Scientific Corporation), the only LAA closure device that is FDA approved for this indication. Our focus on structural disease concludes as we asked Dhanunjaya Lakkireddy, MD, and Brian Whisenant, MD, “What is the impact of the Watchman approval on structural practice? What are the roles of the electrophysiology and interventional cardiology physician?”
Adding to our issue’s main topic, we offer a look at Today’s Practice, Imaging, and Coding & Reimbursement. Issam D. Moussa, MD, examines why few programs have made the shift toward outpatient percutaneous coronary intervention, despite the favorable clinical evidence for this practice. Daisuke Nakamura, MD; Setsu Nishino, MD; Guilherme F. Attizzani, MD; Hiram G. Bezerra, MD; and Marco A. Costa, MD, provide an overview of noninvasive and intravascular imaging technologies to identify and evaluate vulnerable plaque. Finally, Michelle Reese, CPC, describes the necessity of accurate and precise coding in interventional cardiology to ensure that you are properly reimbursed, especially as we shift from the ICD-9 to ICD-10 codes.
Finally, we interviewed Clifford J. Kavinsky, MD, about his current work in fellowship training, structural heart disease research, and the feasibility of opening an outpatient structural heart practice in today’s economic climate.
As is always our goal, we hope this issue helps to synthesize the vast literature on current topics in interventional therapy. The many journals, newsletters, and e-blasts we all receive every week are daunting, and so Cardiac Interventions Today strives to provide a practical distillation of the literature. Please let us know if there are topics you’d like to see in our Journal.
Ted E. Feldman, MD, MSCAI, FACC, FESC
Chief Medical Editor