Washington, D.C., recently hosted Interventional Cardiology’s annual Transcatheter Cardiovascular Therapeutics (TCT) 2000 meeting. The global audience, exceeding 10,000 participants from 82 countries, included all the major players from industry, academia and clinical research, working together to advance the cause of patient diagnosis and effective treatment utilizing interventional vascular- and arterial-based approaches.
The highlight of the meeting continues to be the Live Cases, including 100 procedures from 15 sites in the United States and abroad. These cases serve as a backdrop for the rapid-fire commentary of luminary physicians critiquing the innovative tools and procedures used by their peers with live patients on a table somewhere in the world. While the live broadcasts sometimes suffer from the same technology interruptions we all experience in modern life, the point-counterpoint discussions are courteous, but brutally blunt at times.
As usual, the community-hospital based clinicians in the United States are the target audience for the 150-plus vendors in the exhibit hall. While academic research centers work on the oh-so-esoteric approaches at the leading edge of treatment, workaday clinicians are more focused on effective, fast, safe and proven strategies for managing patient procedures within the confines of an 8- to 10-hour day (i.e., balloons, stents and closure devices) — a strategy commonly known as “Healing hearts, getting paid.”
Looking Ahead — Stroke Therapy
It’s time to address stoke therapy seriously — this is the conclusion from both John Connors III, M.D. (INOVA Fairfax Hospital, Va.) and Alex Berenstein, M.D. (Beth Israel Medical Center, N.Y.), participants in a debate on peripheral vascular interventions titled “Acute Stroke Interventions — Primary Angioplasty for the Brain?”
To date, there is little data from clinical trials and little training for knowledgeable interventional cardiology practitioners who wish to pursue vascular diagnosis and treatment strategies that reach into the brain. The anatomy is different, the vessels react differently to treatment — but ultimately, the reopening of narrowed vessels should improve outcomes. This looks like an opportunity for a new specialty with a huge market, especially for endovascular surgeons who know the landscape and can learn the techniques from their cardiovascular brothers and sisters.
Heart Replacement Therapy? — Land of Dr. Oz
Mehmet C. Oz, M.D. (Columbia University, New York Presbyterian Medical Center, N.Y.) continues to push the envelope in treating cardiovascular disease. In his talk on “Surgical Therapies for the Failing Heart…,” he envisions the use of left ventricular assist devices (LVADs) as a permanent heart replacement therapy, as an alternative to transplantation. In the United States alone, he estimates a need for some 50,000 transplants annually, with only 2,000 patients receiving such transplants. LVADs currently are used to assist patients recovering from heart disease and also serve as a bridge to transplantation.
“We’re getting closer to the endpoint when we will see LVAD devices used as an alternative to heart transplantation, potentially the largest growth area for cardiac surgery,” Oz says. While the technology appears workable and the benefits provable, the procedural cost (always the cost) may limit access to this therapy. However, Oz has a magical track record of paving the way for new treatments and therapies.
RAS — Another Hidden Opportunity
Renal artery stenosis (RAS) historically has managed to avoid medical recognition, diagnosis and treatment, according to Kenneth Rosenfield, M.D. (St. Elizabeth’s Hospital, Boston). The problem? RAS is considered a silent disease, as the size and function of the kidney often decreases without clinical signs. Subtle deterioration is tough for physicians to follow, and hypertension medications may have a negative effect on the kidney. His call to the attendees: Let’s do more for these patients in the form of diagnosis and treatment, supported by clinical trials that prove the effectiveness of site-specific therapies.
Imaging Too
Cardiac PACS are continuing to mature as vendors and clinicians equalize their knowledge and understanding of the benefits of these systems. While 15 suppliers of products populated the TCT exhibit hall, you can buy a system in several methods (direct, dealer, Internet), from industry specialists, major OEMs or startups and pay almost as much or as little as you choose. Archiving strategies deserve a major share of the evaluation focus, along with workflow protocols and Internet compatibility. Important reminders are appropriate: Consultants can help, check another installed site, and also learn what an ASP approach will cost over time. Finally, add HIPAA to your lexicon, right next to DICOM, HL7 and IHE.
Doug Orr, president of J&M Group (Ridgefield, Conn.), consults with medical device companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to [email protected].
