Advances in treating structural heart disease were highlighted at Miami Valves 2022, a three-day conference presented by the University of Miami Miller School of Medicine, the UM International Medicine Institute, and UHealth – the University of Miami Health System.
“New tools to treat valvular heart disease and other structural problems are being developed at a rapid pace,” said conference director Eduardo de Marchena, M.D., professor of medicine and surgery, associate dean for International Medicine, and director of Interventional Cardiology. “We also learn from our colleagues by sharing insights from challenging and complex patient cases.”
More than 360 professionals from 22 states and 18 countries attended Miami Valves 2022, held virtually and in person on February 3-5 at the Marriott Miami Biscayne Bay.
“After the global challenges of COVID, we were glad to bring professionals together again for our 22nd conference,” said Dr. de Marchena, noting that there were 141 sessions, presented by 79 UM and guest faculty members.
“More than 50 abstracts were submitted and presented by residents and fellows as our conference continues to engage future and early-stage cardiologists in research and education.”
In addition to the structural heart meeting, moderated by Dr. de Marchena, the Miami Valves conference included a Percutaneous Coronary Intervention (PCI) Symposium directed by Mauricio G. Cohen, M.D., professor of medicine, and director of the Cardiac Catheterization Laboratory; an Electrophysiology Symposium directed by Raul D. Mitrani, M.D., professor of clinical medicine and director of clinical cardiac electrophysiology; and a Heart Failure Symposium led by Luanda Grazette, M.D., M.P.H., clinical associate professor of cardiology.
Igor Palacios, M.D., professor of medicine at Harvard Medical School and Massachusetts General Hospital, gave the keynote lecture, “Mitral Valve Disease: What a Journey,” discussing the progress in interventional cardiology since treating his first 10 patients in Venezuela in 1987.
Joseph Lamelas, M.D., chief and program director of cardiothoracic surgery, gave presentations on using minimally invasive surgical procedures to replace an aortic root and valve, and to treat mitral annular calcification (MAC).
“Mini-thoracotomy is an acceptable alternative to conventional and transcatheter procedures in patients with extensive valve disease and calcification,” he said. “While there is a long learning curve for these complex procedures, patients typically have shorter hospital stays and faster recoveries compared with traditional surgeries.”
Advances in TAVR
Dr. de Marchena opened the conference with a talk on “Catheter Based Treatment of Structural Heart Disease,” focusing on transcatheter aortic valve replacement (TAVR) procedures, in patients with mitral, bicuspid and tricuspid disease.
“We have seen immense growth in TAVR procedures since 2012,” he said. “We are now treating low, intermediate and high-risk patients, and the median age has declined. However, Blacks and Hispanics are dramatically underrepresented, as Whites constitute 92 percent of TAVR patients nationally. We must do a better job to be sure that all groups have access to these procedures.”
Dr. de Marchena said most TAVR patients have one-day admissions, and feel better after their procedures. While the procedure costs more than an equivalent surgery, the follow-up costs are lower, and after two years TAVR is slightly less expensive.
Following the talk, Eberhard Grube, M.D., professor at University Hospital in Bonn, Germany, emphasized the importance of using CT imaging to determine the right valve size, as well as other TAVR best practices in maximizing patient outcomes.”
In a talk on neuroprotection, Carlos Alfonso, M.D., associate professor of medicine, looked at the use of embolic protection devices (EPDs), such as mesh baskets, to capture debris from valve replacement procedures and reduce the risk of a stroke or other brain injuries.
“Many patients fear stroke more than death, and it is important to look at how to incorporate neuroprotection into cardiology practices,” he said. “Good valve implant techniques can reduce the risk of embolization, and deploying filters can catch debris that could lead to a clinical or silent cerebrovascular problem.”
Recent studies show both in-hospital and 30-day stroke rates have trended down for cardiology intervention patients, but increased use of EPDs is not associated with better outcomes.
“We are hoping to have answers on EPD effectiveness from a multicenter PROTECT-TAVR trial, and will be enrolling participants sometime this summer,” said Dr. Alfonso.
Dr. Mauricio Cohen moderated the PCI Symposium, which included a variety of topics and a panel discussion with experts from leading institutions in the U.S.
“The highlights included case presentations showing the challenges practitioners face in their daily practices,” he said. “There were animated discussions about the best ways to approach these procedures in the cardiac catheterization lab.”
Attendees heard Jacquie Tamis-Holland, M.D., of Mount Sinai in New York, discuss the new 2021 Coronary Revascularization Guidelines that will guide the care of patients with coronary artery disease, and Dr. Alfonso gave a presentation on new tools and approaches for chronic total occlusion interventions.
Interventional cardiologist William O’Neill, M.D., of the Henry Ford Health System in Detroit, shared his journey of taking care of patients with myocardial infarctions and how PCI became the standard of care, and Rajiv Gulati, M.D., Ph.D., of the Mayo Clinic in Rochester, Minnesota, gave a tour de force presentation on the management of spontaneous coronary artery dissection, a problematic condition that mostly affects women. Other panelists included Drs. Pedro Moreno, Ian Gilchrist, Abdulla Damluji, and Michael Dyal.
Roger Alvarez, D.O., M.P.H., a vascular specialist with the UM Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, closed the symposium with a presentation on the development of team protocols for pulmonary embolism response teams (PERTs), a very relevant topic, as interventional techniques are central in the care of patients with pulmonary embolisms.
Addressing Atrial Fibrillation
At Friday’s Electrophysiology Symposium, Jeffrey J. Goldberger, M.D., M.B.A., chief of the Cardiovascular Division, discussed risk factor modification strategies for controlling atrial fibrillation (AF).
“While not a hot new device or procedure, risk-factor modification can be an important step in improving outcomes in patients with atrial fibrillation,” he said. “An aggressive, physician-led program to control risk factors such as weight, blood pressure, sleep apnea, and smoking can be beneficial to patients in many ways.”
Dr. Goldberger is co-leading a Miller School study on the use of liraglutide, a weight-loss medication, to improve long-term outcomes following atrial fibrillation procedures.
“It is important to address the underlying disease process that generates atrial fibrillation, just as statins are used for treating coronary artery disease,” he said.
Enrollment is now underway for the study, funded by the National Institutes of Health (NIH), which involves assessing medical treatments to reduce epicardial fat around the heart prior to electrophysiology treatments.
“By getting the heart tissue into better shape, we hope to achieve better patient outcomes,” said Goldberger said. “We are also conducting other studies looking at the genes affected by epicardial fat in atrial fibrillation patients, as well as metabolic products in the blood. Hopefully, we will see significant advances in the next few years.”
Discussing Heart Failure
In the Heart Failure Symposium on Saturday, Joshua M. Hare, M.D., Louis Lemberg Professor of Medicine, and the founding director of the Miller School’s Interdisciplinary Stem Cell Institute, presented new findings on using stem cells for treating muscle damage to the heart.
Nina Thakkar Rivera, D.O., Ph.D., a specialist in heart failure and transplantation cardiology, led a case-based discussion and review of invasive hemodynamics and updates to current recommendations. Leslie Miller, M.D.. professor of medicine and past president of the International Society of Heart and Lung Transplantation (ISHLT) and the American Society of Transplant Physicians discussed future innovations in mechanical circulatory support for heart failure.