Kamel Shibbani, MD
A Welcome Message and a Pleasant Surprise!
Greetings from everywhere around the world! The 2020 PICS Symposium kicked off with a welcome message from its chair, Dr. Ziyad Hijazi, who began the conference with a special announcement. In response to encouragement from the CHD interventional community, Dr. Hijazi announced the formation (and first official day!) of The Pediatric and Congenital Interventional Cardiovascular Society (The PICS Society), by and for those dedicated to minimally invasive treatment of congenital heart disease.
In his remarks, Dr. Hijazi (who serves as the Society’s Founding President) noted “the Society’s mission is to promote the highest quality care globally for children and adults with CHD through minimally invasive cardiovascular techniques.” He added that “The PICS Society will partner with the congenital interventional community to further knowledge and skills of all involved, and foster research and advocacy worldwide.”
Founding Vice-President Damien Kenny, MD added that the Society’s vision is ambitious and vital: “a world where anyone who can benefit from minimally invasive techniques to treat CHD has access to safe, effective care.”
Dr. Hijazi stressed that the genesis of the Society was based on hundreds of conversations with colleagues around the world, who universally urged that “We need our own home, and our own voice.” He emphasized The PICS Society will be that home, welcoming all members (and all disciplines) of the care team.
Dr. Kenny added there will be many opportunities for members to become involved, through committees focusing on education, guidelines, quality, early career, advocacy and much more.
Dr. Hijazi concluded by adding that through global unity and partnership, our community will finally have the strong voice we need to further our profession and serve our patients. Finally, he introduced the board of directors that consist of the following imminent interventional cardiologists: Dr. Damien Kenny-VP; Dr. Jacqueline Kreutzer-Secretary; Dr. Frank Ing-Treasurer; Dr. Lee Benson, Dr. Mario Carminati and Dr. Carlos Pedra as board members. “Join us!” Those interested in volunteering should contact the society at info@CHDinterventions.org.
Applications for enrollment as founding members are available at membership@chdinterventions.org.
This year’s meeting faces a special hurdle of moving online, but continues to provide excellent learning and collaborative opportunities, nonetheless. Such opportunities include live cases from six international sites covering sinus venosus ASD closure, VSD closure, transcatheter pulmonary valve replacement, and much more. In addition, taped cases will include transcatheter Glenn completion and airway interventions.
Besides these cases, there will be didactic lectures that cover a broad range of topics ranging from imaging, to interventions in very low birth weight premature infants, to sessions geared towards nursing and technologists.
Live and Taped Cases
The first event of the day were the ever-popular live cases! We started out with a case from NYC at Colombia. First though, Dr. Julie Vincent was recognized for her excellence. She retires this month after years of innovative work and was recognized by PICS for her dedication and tremendous contribution to the field! Next, she introduced her team, which consisted of Drs. Alejandro Torres, Matthew Crystal, Mariel Turner, and Oliver Barry, among others. The live case they performed was a successful transcatheter pulmonary valve implantation with a Edwards SAPIEN 3 valve!
Next, we moved to Dublin, Ireland, where Drs. Damien Kenny and Kevin Walsh walked us through the successful implantation of a 29mm SAPEIN S3 valve using 3D overlay! Due to technical difficulties, the case was not broadcast live, but was taped and subsequently played and commented on by Dr. Kenny and Walsh.
Session 2 was a taped case session which started from New Orleans, were Dr. Kiran Mallula walked us through the stenting of an RV outflow tract in a 2kg infant. Dr. Mallula invited the audience to take polls throughout his presentation in what proved to be a very interactive and interesting talk!
Dr. Lee Benson then introduced Dr. Allison Cabalka from Mayo Clinic, who presented an LV pseudoaneurysm closure in a 43-year-old female with mitral valve prolapse. This challenging case provided much food for thought as the panelists discussed the use of overlay technology to provide more enhanced information and imaging during the case. Dr. Cabalka touched on their use of a 3D PDF to help provide more insight into the patient anatomy.
Fetal Interventions
After a short break, PICS 2020 resumed with a more focused session looking at fetal interventions moderated by Drs. Vivian Dimas and Alex Javois. Dr. Tworetzky started the session with an insightful talk that highlighted the lessons learned about fetal interventions over the past 20 years and the monumental steps that this field has taken is such a short time! He focused on fetal cardiac interventions in patients with aortic stenosis and HLHS and shared the Boston experience with the audience. A quick trip across the Atlantic landed us in Austria, where Dr. Tuzer talked about the outcomes of fetal aortic valvuloplasty and the experience that they have had at the Kepler University Hospital.
Next, Dr. Fontes-Pedra, form Sao Paulo, discussed registry data and the information we can derive from it. In particular, she talked about how to identify an “ideal center volume” such that success rates are increased, and complications are decreased. Questions where then entertained by the panelists and Dr. Simone-Pedra. Following his self-professed “better-half’s” presentation, Dr. Carlos Pedra gave a wonderful talk about treatment options for the fetus with pulmonary atresia, highlighting the benefits of fetal pulmonary valve valvuloplasty and how it results in better survival rates and biventricular circulation. An interesting question from the audience revolved around the identification of coronary sinusoids and the risk of coronary ischemia after PV valvuloplasty. Along the same lines but tackling a slightly different topic, Dr. Aimee Armstrong from Nationwide Children’s talked about fetal transcatheter pulmonary valve replacement. She introduced the idea of tissue engineered heart valves that can grow with the fetus and limit the problems of stenosis requiring subsequent interventions. This exceptional session was concluded with a very interesting Q&A.
Live Cases
We then switched gears and moved back to two fantastic cases, revisiting New York and Dublin. We started at New York Presbyterian Hospital where Dr. Torres and his team performed a challenging VSD closure with a Medtronic Melody Valve. Drs. Kenny and Walsh next performed a VSD device closure with proximal LPA stenting.
Lunch Symposium – A Neonatologist’s Perspective for Interventional Cardiologists on PDA Closure in LBW Babies
Dr. Patrick Mcnamara, a world leader in neonatal hemodynamics, next talked about PDA closure in premature infants. Although the talk was cut short due to technical difficulties, there was a great discussion in the chat room with Dr. McNamara where he fielded questions about best timing for PDA closure and the adverse effects of waiting too long. Of note, Dr. McNamara’s talk will be uploaded to the website in full for review after the fact.
Dealing with Complications
After the industry symposium was completed, we turned out attention to complications in the cath lab, moderated by Dr. Holzer and Nykanen. The session was kicked of by Dr. Brian Quinn who defined and talked about adverse events in the cath lab. Dr. Quinn talked about data from the IMPACT registry, as well as the effect of COVID 19 impact on case complexity. Next, Dr. Holzer talked about how to best prepare for adverse events by creating proper workflows and management strategies that can improve procedure results and patient outcomes. Dr. Ching then brought in the perspective of an emergency medicine physician and talked about the importance of simulation in preparedness for cath lab complications. Following Dr. Ching’s talk, Dr. Sathanandam from Le Bonheur talked about the very relevant topic of COVID and its impact on the world of interventional cardiology, highlighting the many lessons learned and areas where we can still improve as we continue to learn from this pandemic. We shifted gears slightly when Dr. Wu from Johns Hopkins talked about how to deal with the emotional fallout of complications and catastrophic events. Finally, Dr. John Moore gave a very insightful talk about learning from adverse events and translating them into strengths and improvements.
Oral Abstract Presentation
Two oral abstract sessions took place simultaneously, to conclude the first day of the 2020 PICS! In the first session, Dr. Sarah Fahnhorst from Cincinatti Children’s talked about cardiac troponin in cardiac cath. She provided helpful data showing that troponin I is significantly higher in interventional procedures compared to diagnostic procedures. Next was a very interesting talk from Jennifer Williams from Medtronic, that looked at cost of transcatheter pulmonary valve replacement (TPV) as compared to surgical pulmonary valve replacement (SPV) in US hospitals, and found that overall costs of TPV were similar to SPV. Next Dr. Gaffar from UC Irvine talked about their experience with Left Ventricular Decompression in VenoArterial ECMO. Dr. Sterling from Holtz Children’s Hospital talked about the use of CRIPS score in pediatric adults with CHD, Dr. Tomasulo from CHOP about Intramesenteric Lymphatic Imaging, a talk from Dr. Davtyan from UCSD about Melody endocarditis, a talk from Dr. Chakraborty about PDA closure in premies, a talk by Dr. Umapathi from Rush about transcatheter vs surgical closure of ostium secundum ASD’s, a talk by Dr. Linnane from Children’s Health in Ireland about RVOT stenting without long delivery sheaths, and finally, a talk by Dr. Shahbah, from Texas Children’s Hospital about early outcomes in neonates <2.5kg with PDA stents. In the second session, which occurred simultaneously, featured a talk by Dr. Schramm from Children’s National about radiation savings in heart transplant patients by using MR guided cath technique. This was followed by a talk about the impact of sheath size on pulse loss by Dr. Swanson from Indiana University. Dr. Relan from the All India Institute of Medical Science next talked about the use of CT to better delineate anatomy of superior sinus venosus intratrial communication. Dr. El-Said from UCSD then talked about the use of BT shunts in the time of PDA stents. This was followed by Stanford’s Dr. McElhinney’s talk about the Harmony Transcatheter Valve Pivotal Trial, then, from Ohio State, Dr. Berman’s talk about the Melody transcatheter pulmonary valve and its use in the past 10 years. Dr. Zahn from the Cedar Sinai Medical Center talked about the Alterra prestent and SAPIEN 3 transcatheter valve, as well as giving a second talk about the Renata Minima Stent and delivery system. Dr. Callahan from Boston Children’s talked about the correlation between IVUS and histology in pulmonary vein stenosis, Dr. Herron from Michigan talked about percutaneous balloon pericardiotomy, and finally, Dr. El-Sabrout talked about the requirements of the transcatheter Cavo-pulmonary anastomosis device.
Keep a Look Out for Tomorrow!
Don’t miss out on the fantastic learning opportunities at PICS tomorrow, when we pick up where we left off with live and taped cases, talk about 3D printing and interventions in the premature infant, and discuss advances in imaging along with much much more!