‘What’s not hot in interventional cardiology?’ asked Professor Darren Walters interventional Cardiologist at the Prince Charles Hospital during the plenary session at this year’s CSANZ scientific sessions.
“Its an incredibly exciting field to work in – the pace of change is like no other and you can rest assured that Australia and New Zealand is at the forefront of this technology,” he told a packed auditorium.
In the session titled, what’s hot in interventional cardiology Professor Walters warned cardiologists of a ‘tsunami’ of valvular heart disease about to hit the health system. Poised to surpass coronary artery disease, Professor Walters predicts it will be the next big burden of disease.
“Degenerative aortic stenosis is incredibly common; it’s growing in frequency in our ageing population. Without treatment these patients do terribly and up until recently a lot of patients were being rejected for surgery.”
Professor Walter also told delegates that rapid innovations in TAVI would soon see the minimally invasive procedure surpass surgery as the standard of care over the next few years.
“TAVI is ready for prime time. There’s an incredible amount of evidence now, multiple randomised control trials and meta analyses, showing equivalence for surgery in intermediate risk groups and some studies show superiority over surgical outcomes.”
He went on to say that in the Australian experience outcomes for TAVI are as good if not better than the published results from overseas trials.
According to Professor Walters the procedure will be MBS listed for patients at high risk for surgery later this year.
“We have institutional and operator requirements for TAVI clearly elucidated now in this group of patients and MBS item numbers are just about ready to go. The surgical heart team review will be import as part of this and we will have a nationally mandated database of accredited centres and operators who are going to undertake this procedure. We expect it to go live in November 2017 so be ready for it.”
But there have also been heart clutching moments over the past year he said, talking about the controversy surrounding bioresorbable stents, which saw the device recalled in Australia, Europe and the US after two year outcome data revealed a disturbing excess rate of target lesion failures compared to a drug eluting stent.
“It’s back to the drawing board with bioresorbable stents. I was at the ACC when data from ABSORB III was presented … its been a significant set back for the technology and caused us all to clutch our chest as we rang up patients to inform them of the recall.”