Hemodynamics Galore: What I Learned at the C3 Summit

2016-2017 Fellow Talk Bloggers     
 

Last month, I attended the Complex Cardiovascular Catheter Therapeutics: Advanced Endovascular and Coronary Intervention Global Summit—C3, as it’s more commonly known—for the second time. Held annually in Orlando, FL, the course attracted nearly 1,200 international attendees interested in complex coronary, structural, and peripheral interventions. I was fortunate enough to receive one of 15 scholarships awarded to trainees from the United Kingdom.

In particular, two hemodynamic support symposia held there surpassed my intellectual expectations.

The first aimed to provide attendees with a practical approach to cardiogenic shock. With a growing demand for hemodynamic support devices in the context of high-risk PCI, the speakers used pressure-volume loop analysis to describe these devices’ benefits. While the IABP-SHOCK II trial showed that use of an intra-aortic balloon pump (IABP) in patients with acute MI complicated by cardiogenic shock did not improve short-term mortality compared with optimal medical therapy, the majority of IABP placement in that trial was performed after PCI. In addition, presenters in this session pointed to the results of BCIS-1, which showed a long-term mortality benefit from IABP use in high-risk PCI in patients with a high jeopardy score (as this was conducted before the Syntax score was available). Panelists at C3 suggested using these devices in a stepwise manner, starting with IABP support then progressing to Impella (Abiomed) and finally to extracorporeal membrane oxygenation (ECMO) or the TandemHeart percutaneous ventricular assist device (CardiacAssist) if necessary. Most interestingly, they said these devices should be seen as complementary rather than competing and that only one-quarter of cath labs in the United States, according to a recent TCTMD poll, have access to device technology such as Impella.

In a second hemodynamic support session, Daniel Burkhoff, MD, PhD (Cardiovascular Research Foundation, New York), discussed the principles underlying mechanical circulatory support. Burkhoff is an excellent speaker, frequently delivering live demonstrations from his Harvi iPad app, which can simulate with the aid of pressure-volume loops (of the left and right atria and ventricles) a patient in cardiogenic shock, an acutely occluded LAD, and subsequent hemodynamic collapse. This fantastic tool allows you to induce cardiogenic shock, implant a device, and track the effects in real-time so that you can gauge the effects on hemodynamics including pulmonary capillary wedge pressure, mean arterial pressure, coronary artery blood flow velocity, cardiac output, and the ventricular-arterial interaction. I thoroughly enjoyed this session, as it made an extremely complicated topic seem relatively straightforward.

C3 provided and excellent opportunity for networking and learning, with live case demonstrations, stimulating discussion, and presentations in a relaxed environment. For fellows and practitioners interested in attending C3 next year, scholarship details can be found here. For UK fellows specifically, check with the British Cardiovascular Intervention Society.