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What is a hot topic in structural heart intervention that attendees can expect to hear more about at the SCAI Scientific Sessions? 

SCAI has an entire session focused on tricuspid regurgitation. The timing is perfect with the recent approval of the Edwards EVOQUE Tricuspid Valve Replacement System and the very positive recommendations from the FDA panel for Abbott’s TriClip. We may have technologies on the shelf in the not-too-distant future for the treatment of tricuspid regurgitation. I think there will be a lot of excitement among attendees to learn more about tricuspid disease. Tricuspid valve disease is definitely more complex than aortic valve disease, which we have gotten close to mastering. The tricuspid valve is anatomically more complex, imaging is more challenging, assessment of right ventricular function (and response of the right ventricle to tricuspid regurgitation treatment) can be difficult. All of this, as well as a survey of the device landscape, will be discussed and case examples will be shown. Lastly, there will be a debate pitting repair versus replacement as the preferred approach for tricuspid regurgitation. 

What other structural heart topics will be presented? 

Of course, we cover transcatheter aortic valve replacement (TAVR) and this year will focus on lifetime management of aortic stenosis. There will be a session on mitral regurgitation that will discuss imaging, current repair technologies, and upcoming transcatheter mitral valve replacement technologies. There will be an entire session on left atrial appendage closure. There will be a leak closure session covering atrial septal defects, ventricular septal defects, paravalvular leaks, and other important structural heart disease procedures. I am excited about the complications session, which is a crowd favorite and is always well-attended. It will be a case-based session offering practical approaches and bailout strategies to common structural heart complications. The debate session is another popular one. As previously mentioned, we will have a tricuspid regurgitation repair versus replacement debate. We will also talk about the pros and cons of cerebral embolic protection. The third debate topic is surgery versus TAVR in the young patient. Finally, live cases will be broadcast from Cedars-Sinai, Medical University of South Carolina, Stanford University, and the Washington Hospital Center. 

What are the current concerns around TAVR that will be covered? 

The principal concern is lifetime management of the aortic valve disease patient. As we are treating healthier and younger people, the question becomes, if this valve fails, what do you do next? We are trying to predict who can undergo a redo TAVR and who might have potentially life-threatening issues such as coronary occlusion or sinus sequestration. If we are concerned that a patient may be at risk for coronary occlusion with transcatheter aortic valve-in-valve (TAV-in-TAV), should they have surgical aortic valve replacement (SAVR) as their first procedure? Presenters will discuss how to use computed tomography angiography (CTA) to model TAV-in-TAV to predict whether the patient is at risk for coronary occlusion with TAV-in-TAV. The other question is, if someone has already had a TAVR and subsequently is determined to be at risk of coronary occlusion, what can we do to mitigate that risk? What strategies do we have with leaflet modification or leaflet removal to try to prevent risk? What new technologies are coming down the line that might facilitate treatment? 

It speaks to the importance of imaging, not just during the procedure, but preprocedure as well. 

Absolutely. Imaging is so very important that every one of the SCAI structural heart sessions has an imaging focus. Imaging physicians who are members of SCAI will be presenting on CTA and echo imaging (including intracardiac echo) for preprocedure evaluation and case planning, as well as intraprocedural guidance for valvular heart disease, left atrial appendage occlusion, and other leak closures. Imaging is vital to the diagnosis and treatment of structural heart conditions, and therefore it is a crucial focus in each of our sessions. 

What will presentations cover for left atrial appendage closure? 

There are a number of topics to discuss. One is whether we able to make the procedure more efficient by using intracardiac echo (ICE) instead of transesophageal echo during the procedure. With ICE, we can do the procedure without general anesthesia and without tying up an echo doc. Echocardiologists are stretched so incredibly thin that being able to do these procedures without an echocardiologist and without anesthesia will certainly make them more efficient. We will discuss what operators need to know in order to be able to do an ICE-guided appendage closure. We will also survey currently approved devices as well as those undergoing clinical investigation, and discuss potential advantages and disadvantages of these devices. Lastly, we will be reviewing potential complications of left atrial appendage closure. We will discuss peri-device leak and device-related thrombus, how to potentially minimize risks, and how to manage them. Presenters will also be discussing periprocedural medical management.

How will the structural heart team be a focus at SCAI? 

SCAI is attracting not just interventional cardiologists, but imaging-focused physicians, who are critical to structural heart procedures. As we move into the treatment of tricuspid valve disease as well as mitral replacement, imaging physicians will become even more important and integral to the world of structural heart disease. The position of the surgeon as a member of the team is enduring and remains solid. SCAI will have surgical faculty participate in every structural heart session. There still are patients who are better served with surgery, so having surgeons sitting at the table talking about the pros and cons of surgical approaches versus catheter approaches is key. We have learned so much from each other and patients benefit from our different skill sets. Going forward, I’m certain that the multidisciplinary nature of the structural heart team will remain strong. 

Learn more and register at 
https://scai.org/scai-2024-scientific-sessions 

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