Training program guidelines, case numbers, and maintenance of certification
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
Interventional cardiology is one of the most rapidly growing fields in medicine as novel procedures and technologies are constantly being integrated into clinical practice. As such, training requirements must evolve to keep pace with these innovations. The training pathway must be continuously assessed to assure adequate exposure to critical components of modern intervention. Enhanced training pathways to assure proficiency in noncoronary cardiac and vascular interventions are in nascent stages of development. Continued trainee exposure to these disease entities will likely be followed by further educational initiatives, expectations of competency, and expansion of training and certification requirements to document mastery. Whether training standards for peripheral vascular disease and interventions should remain distinct from those established for cardiovascular interventional training remains a point of debate.
Infection control procedures
John Edward Boland, David W. M. Muller in Interventional Cardiology and Cardiac Catheterisation, 2019
Infectious risks of interventional cardiology procedures may be classified in several ways. We find it useful to consider separately the risk of blood-borne viruses, infections associated with vascular access or incision sites, and infections related to permanently retained devices. Blood-borne virus infections are uncommon so long as single-use devices are not reprocessed or reused. Such transmission events are generally either patient-to-healthcare-worker, or rarely, healthcare-worker-to-patient. Vascular access infections are uncommon in electrophysiology, due to predominantly venous catheterisation sites and short device dwell-times. Arterial vascular access sites are more prone to infection, particularly if arteriotomy closure devices are used. Infection of coronary stents is remarkably rare.
Acquired Bleeding Disorders Associated with the Character of the Surgery
Harold R. Schumacher, William A. Rock, Sanford A. Stass in Handbook of Hematologic Pathology, 2019
The use of platelet inhibitors in cardiovascular surgery has been looked at briefly, but the results did not initially suggest any benefit. The introduction of platelet inhibitors which work through the Ilb–IIIa binding site on the platelet membrane may change this. Results have suggested that vessel patency may improve if the inhibitors are used postsurgically. Whether there is any direct benefit to using these inhibitors during surgery has not yet been established. The use of the inhibitors may occur in an indirect fashion. Failures in interventional cardiology frequently wind up in cardiovascular surgery, and the inhibitors are finding more and more use in interventional cardiology. These platelet inhibitors have potent effects and have the capability of producing serious bleeding when coupled with the use of heparin.
How Will the Heart Team Evolve?
Published in Structural Heart, 2019
Anthony N. DeMaria
A more intriguing question is what the role is for surgeons in performing percutaneous transcatheter procedures. Cardiac surgeons are intelligent people, and clearly very dexterous. There is little question that, with the appropriate time and training, they can master interventional catheterization techniques. Already there are some institutions in which cardiac surgeons are pursuing additional training in cardiac catheterization, usually up to one year and typically devoted to structural heart disease. Of course, performing the procedure is only part of interventional cardiology. Physiology and the other cognitive aspects of cardiology should be mastered as well. While such training is likely due to an interest of surgeons to provide the full spectrum of services to valve patients, it is also probable that for some this training is seen as a hedge against the possible loss of surgical volume.
Interventional Cardiology at a Pivot Point
Published in Structural Heart, 2018
Anthony N. DeMaria
Interventional cardiology was born and grew through adolescence to maturity based upon coronary artery procedures. While the role of interventional cardiology in acute coronary syndromes is fully established for nearly all patients and will always exist, transcatheter procedures will likely be more selective in patients with chronic stable angina. A more scientific and quantitative assessment of coronary physiology will be required of interventionalists to select the stable angina patients who are most likely to benefit from PCI. While the number of procedures devoted to coronary disease may plateau, there will be enormous growth in diagnostic and therapeutic approaches for the increasing number of patients with structural heart disease. There is no question in my mind that this pivot to structural disease, while keeping one foot firmly in the coronary space, will lead to an extremely bright future for interventional cardiology.
COVID-19 pandemic and its impact on service provision: A cardiology prospect
Published in Acta Cardiologica, 2021
Sana Adam, Syeda Anum Zahra, Cheryl Yan Ting Chor, Yuti Khare, Amer Harky
The delay in patient presentation to hospital with conditions such as MI could be detrimental, possibly leading to out of hospital cardiac arrest. Analysis carried out in France highlighted that there was a 13% increase in out of hospital cardiac arrests [21]. A proportion of these cases can be attributed directly to infection with COVID-19, however, in patients who tested negative for COVID-19 the indirect effect of the virus such as heightened public anxiety, perceptions that hospitals are areas of high infection transmission and reorganisation of the healthcare system may have contributed to the increase in out of hospital cardiac arrests. A study conducted to evaluate the use of the handheld ECG in India found it to be valuable in monitoring heart disease remotely [22]. Such technology could be valuable for use with high-risk patients as it can allow for immediate examination and can help prevent patients going into cardiac arrest both in-hospital and out of hospital [23]. Currently, the literature on the long-term impact of delaying interventional cardiology procedures due to the pandemic is limited. Future studies could evaluate the long-term effects of delaying interventional cardiology procedures and could help identify strategies to decrease their impact on cardiovascular morbidity and mortality.
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