SCAI Survey Highlights Need for Advanced Structural Heart Disease Training

July 30, 2012—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that results of a survey by SCAI's Early Career Task Force show that new structural heart disease (SHD) interventions over the past decade are driving demand for advanced interventional cardiology training programs, but that training in this specialized area remains in its infancy. Konstantinos Marmagkiolis, MD, et al published the findings online ahead of print in SCAI's official journal, Catheterization and Cardiovascular Interventions.

The survey found that while the majority of interventional cardiology training programs involve structural interventions—such as transcatheter aortic valve replacement, pulmonic valve implantation, and mitral valve repair—few offer dedicated SHD fellowships.

“Structural heart disease care has changed significantly in recent years, and new treatments require specialized training on complex interventions,” commented survey investigator Mehmet Cilingiroglu, MD, in the SCAI announcement. “Our survey found SHD training remains in its early stages. As we advance care for patients, it's essential that we establish structured training programs with standardized requirements that can help new interventional cardiologists build their skills in this important area.”

SCAI stated that the SHD Early Career Task Force was established in 2011 to provide a forum for interventional cardiologists who are seeking advanced SHD training or are currently involved in a SHD program. SCAI President J. Jeffrey Marshall, MD, commented in a press release, “As interventional cardiology advances, so do our education and training needs. SCAI is committed to continuously improving education programs to equip cardiologists with the necessary tools and resources to provide the best care for our patients.”

As summarized by SCAI, the survey of 50 interventional cardiology programs accredited by the Accreditation Council for Graduate Medical Education found that 86% of institutions responding to the survey offer percutaneous treatments for SHD. Among those institutions, 29% (n = 9) offer a 1-year training program in SHD after completion of interventional cardiology training. The majority (51.6%; n = 16) integrate structural training with coronary and peripheral intervention training.

More than a third of training (39.3%) is achieved by assigning cases throughout the year to the fellow, while a quarter takes place through participation in specialized conferences or courses. More than half of program directors (58.6%) believe time dedicated to SHD training in the first year of interventional cardiology training is not enough.

In its press release, SCAI outlined the challenges identified in the survey for achieving optimal training, both through current programs and in the pursuit of developing additional training and fellowship programs. One is that the average number of SHD procedures performed per year in the studied institutions is less than the recommended number of procedures to gain proficiency.

Another challenge is that there are a total of 15 types of SHD procedures and currently no interventional cardiology fellowship programs in the country that can offer sufficient training in all 15 types. One solution identified to overcome this is combining rotations in different institutions so training in all the required types of procedures can be achieved. Also, several types of procedures are trial-restricted and inaccessible to the training fellows. Based on the survey, the task force called for a structured curriculum for SHD training with uniform requirements.