Cardiology

Naidu, S.S., Coylewright, M., Hawkins, B.M., Meraj, P., Morray, B.H., Devireddy, C., Ing, F., Klein, A.J., Seto, A.H., Grines, C.L., Henry, T.D., Rao, S.V., Duffy, P.L., Amin, Z., Aronow, H.D., Box, L.C., Caputo, R.P., Cigarroa, J.E., Cox, D.A., Daniels, M.J., Elmariah, S., Fagan, T.E., Feldman, D.N., Forbes, T.J., Hermiller, J.B., Herrmann, H.C., Hijazi, Z.M., Jeremias, A., Kavinsky, C.J., Latif, F., Parikh, S.A., Reilly, J., Rosenfield, K., Swaminathan, R.V., Szerlip, M., Yakubov, S.J., Zahn, E.M., Mahmud, E., Bhavsar, S.S., Blumenthal, T., Boutin, E., Camp, C.A., Cromer, A.E., Dineen, D., Dunham, D., Emanuele, S., Ferguson, R., Govender, D., Haaf, J., Hite, D., Hughes, T., Laschinger, J., Leigh, S.M., Lombardi, L., McCoy, P., McLean, F., Meikle, J., Nicolosi, M., O’Brien, J., Palmer, R.J., Patarca, R., Pierce, V., Polk, B., Prince, B., Rangwala, N., Roman, D., Ryder, K., Tolve, M.H., Vang, E., Venditto, J., Verderber, P., Watson, N., White, S. and Williams, D.M. (2020). “Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions 2020 think tank.” Catheter Cardiovasc Interv Aug 25. [Epub ahead of print.].

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The society for cardiovascular angiography and interventions (SCAI) think tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community for high-level field-wide discussions. The 2020 think tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease (CHD). Each session was moderated by a senior content expert and co-moderated by a member of SCAI’s emerging leader mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialogue from a broader base, and thereby aid SCAI and the industry community in developing specific action items to move these areas forward.

Shah, S., Castro-Dominguez, Y., Gupta, T., Attaran, R., Byrum, G.V., 3rd, Taleb, A., Pettyjohn, A., Bartel, R.C., Szerlip, M., Henry, T.D., Mahmud, E. and Applegate, R.J. (2020). “Impact of the COVID-19 pandemic on interventional cardiology training in the United States.” Catheter Cardiovasc Interv Aug 7;10.1002/ccd.29198. [Epub ahead of print.].

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OBJECTIVES: We sought to determine the effect of COVID-19 related reduction in elective cardiac procedures and acute coronary syndrome presentations on interventional cardiology (IC) training. BACKGROUND: The COVID-19 pandemic has significantly disrupted healthcare in the United States, including cardiovascular services. The impact of COVID-19 on IC fellow training in the United States has not been assessed. METHODS: The Society for Cardiovascular Angiography and Interventions (SCAI) surveyed IC fellows training in both accredited and advanced non-accredited programs, as well as their program directors (PD). RESULTS: Responses were received from 135 IC fellows and 152 PD. All respondents noted reductions in procedural volumes beginning in March 2020. At that time, only 43% of IC fellows had performed >250 PCI. If restrictions were lifted by May 15, 2020 78% of IC fellows believed they would perform >250 PCI, but fell to only 70% if restrictions persisted until the end of the academic year. 49% of IC fellows felt that their procedural competency was impaired by COVID-19, while 97% of PD believed that IC fellows would be procedurally competent at the end of their training. Most IC fellows (65%) noted increased stress at work and at home, and many felt that job searches and/or existing offers were adversely affected by the pandemic. CONCLUSION: The COVID-19 pandemic has substantially affected IC training in the United States, with many fellows at risk of not satisfying current program procedural requirements. These observations support a move to review current IC program requirements and develop mitigation strategies to supplement gaps in education related to reduced procedural volume.

Nayak, A., Hicks, A.J. and Morris, A.A. (2020). “Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients.” Circ Heart Fail 13(8): e007264.

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Although care of patients with heart failure (HF) has improved in the past decade, important disparities in HF outcomes persist based on race/ethnicity. Age-adjusted HF-related cardiovascular disease death rates are higher for Black patients, particularly among young Black men and women whose rates of death are 2.6- and 2.97-fold higher, respectively, than White men and women. Similarly, the rate of HF hospitalization for Black men and women is nearly 2.5-fold higher when compared with Whites, with costs that are significantly higher in the first year after HF hospitalization. While the relative rate of HF hospitalization has improved for other race/ethnic minorities, the disparity in HF hospitalization between Black and White patients has not decreased during the last decade. Although access to care and socioeconomic status have been traditional explanations for the observed racial disparities in HF outcomes, contemporary data suggest that novel factors including genetic susceptibility as well as social determinants of health and implicit bias may play a larger role in health outcomes than previously appreciated. The purpose of this review is to describe the complex interplay of factors that influence racial disparities in HF incidence, prevalence, and disease severity, with a highlight on evolving knowledge that will impact the clinical care and address future research needs to improve HF disparities in Blacks.

Hassan, M.F. (2020). “Tissue “valve-over-valve” implantation in previous mechanical Bentall.” J Card Surg Aug 13. [Epub ahead of print.].

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The authors present a case report about the elective replacement of a mechanical Bentall with a bioprosthetic valve. The authors describe a technique whereby the mechanical valve is “broken” off its mechanism and the new valve is sutured in the old cuff.

Gong, T. and Hall, S. (2020). “Considerations and experience driving expansion of combined heart-liver transplantation.” Curr Opin Organ Transplant Aug 10. [Epub ahead of print.].

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PURPOSE OF REVIEW: Heart transplantation concomitant with a liver transplant may be warranted when end-stage heart failure results in irreversible liver failure. Previously reported outcomes have been excellent yet the specific immunoprotective role of the liver allograft is not known. We review the current literature about the immunologic benefit for combined heart and liver transplantation (CHLT). RECENT FINDINGS: The total number of combined heart and liver transplants continues to increase and accounts for approximately 25 cases per year. Familial amyloid polyneuropathy with cardiac cirrhosis is the most common indication for CHLT while adult congenital heart disease (CHD) with associated cirrhosis is increasing in frequency. The majority of recent registry data suggest a statistically equivalent to modestly improved survival advantage for CHLT compared with isolated heart transplantation. Direct mechanisms accounting for this survival advantage are not proven, but combined heart and liver transplants experience lower rates of acute cardiac rejection and cardiac allograft vasculopathy (CAV). SUMMARY: Combined heart and liver transplants remain a small percentage of the total heart transplants worldwide, but the majority of recent literature confirms the safety and viability of this option for patients with end-stage heart and liver disease. Equivalent to modestly improved survival outcomes, lower rates of acute cardiac rejection and CAV warrant further investigation into the liver allograft’s immunoprotective effect on the transplanted heart. The key mechanisms of tolerogenicity have important implications for surgical technique and immunosuppression requirements. Future directions include development of criteria for heart-liver transplant candidacy and identification of equitable allocation protocols.