‘Miami Valves’ International Conference Showcases Advances in Treating Cardiovascular Disease

Advancements in treating cardiovascular disease were showcased at Miami Valves 2023, a three-day international conference hosted by the University of Miami Miller School of Medicine that drew more than 420 professionals from 26 countries.

“New tools to treat valvular heart disease, sudden cardiac death, dangerous arrhythmias, and heart failure 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. “For 21 years, we have brought together our colleagues, researchers, and thought leaders from the Americas, Europe, and beyond to share their insights, new information, and innovation, as well as practical tips on challenging and complex patient cases.”

Held Feb. 2-4 at the new Loews Coral Gables, Miami Valves featured 93 presenters from 90 medical centers in 13 countries. Additionally, 62 scientific abstracts by residents, fellows, and practicing cardiovascular specialists were presented and judged. The annual conference was organized by the University of Miami International Medicine Institute and UHealth – University of Miami Health System, endorsed by the Latin American Society of Interventional Cardiology (SOLACI), and supported by multiple educational funders and exhibitors.

Yiannis S. Chatzizisis, M.D., Ph.D., the new chief of the Division of Cardiovascular Medicine, gave several presentations and noted the international impact of the conference. “Miami Valves is one of the crown jewels of our cardiovascular program, bringing clinicians, researchers, trainees, and industry together in a setting that encourages learning, networking, and gaining hands-on experience [experiential learning] with the latest technologies,” he said.

One of the conference highlights was an emotional tribute to Robert J. Myerburg, M.D., professor of medicine, who joined the faculty in 1970 and served as chief of cardiology from 1974 to 2004. Dr. De Marchena presented Dr. Myerburg with a lifetime achievement award, noting his lasting influence on generations of researchers and clinicians.

“I am very appreciative of this recognition and the support I have received from the medical school through the years,” said Dr. Myerburg, who later highlighted notable advances in cardiology in his keynote lecture on “50 Years of Sudden Cardiac Death Prevention: Progress, Promises and Pitfalls.”

Along with a three-day structural cardiology meeting moderated by Dr. De Marchena, Miami Valves 2023 included a Percutaneous Coronary Intervention (PCI) Symposium directed by Mauricio G. Cohen, M.D., professor of medicine; a Sudden Cardiac Death 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., professor of medicine, clinical associate professor of cardiology, and director of advanced heart failure, heart failure recovery, and therapeutic innovations.

Cardiovascular Training in the Americas

One of the goals of Miami Valves and the Miller School’s International Medicine Institute is to multiply the Miller School’s impact on patient care by bringing new research findings and clinical strategies to professionals throughout Latin America and the Caribbean. “There is a long tradition of Latin American fellows coming to Florida for their training before going back to help develop TAVR [transcatheter aortic valve replacement] and other cardiology programs in their home countries,” said Anibal DaMonte, M.D. president, SOLACI. “We are proud to endorse this year’s meeting and look forward to strengthening those relationships in the future.”

Dr. De Marchena said, “At this meeting, our faculty members instruct medical students, trainees, and professionals on interventional cardiology tools and procedures. This conference also helps us identify new areas for collaboration in research and biotech development, leading to further advances in our field.”

Several Miami Valves presenters were graduates of the William J. Harrington Medical Training Programs for Latin American and the Caribbean, which include fellowships, residencies, and observerships. Rafael Calvacante, M.D., a former Harrington observer and now vice president of medical affairs and education, Boston Scientific, said, “Miami Valves pulls together the U.S. and Latin American cardiology communities, who share their knowledge and experiences here. I always learn from this conference, seeing how practices are approaching and adopting new treatment tools and strategies.”

Structural Cardiology Meeting

To kick off the Structural Cardiology meeting, Dr. De Marchena gave a presentation on “Transcatheter Therapy for Structural Heart Disease: Year in Review.” He noted that TAVR procedures now account more than 60% of aortic valve replacements in the U.S. “We have been able to go to smaller and smaller devices to treat patients at low-and medium risk, as well as high-risk patients,” he said. “Even high-risk patients are now being discharged after a one-day hospital stay, and there is talk about doing same-day TAVR procedures.”

Dr. De Marchena highlighted a 2022 study that suggested the importance of using cerebral protection devices, such as filters, to guard against stroke in valve replacement procedures. He said that mitral valve replacement and repair procedures continue to increase, and that one of the devices now being studied for tricuspid valve disease may be approved in the near future. “It’s been an amazing year for structural heart disease, and the introduction of new devices will carry us further on our journey to keep improving patient care,” he said.

Also looking ahead was Eberhard Grube, M.D., professor of medicine and chief of cardiology and angiology at University Hospital, Bonn, Germany, who spoke on “My Crystal Ball for the Next Decade.”  He said he believes TAVR will be the treatment of choice for patients with isolated aortic stenosis, and that new technologies will make TAVR easier and safer. “We also need to think about lifetime management, particularly for younger patients,” he said. “Our dream is to give a patient one valve for life.”

Joseph Lamelas, M.D., professor and chief, Division of Cardiothoracic Surgery, discussed his extensive experience with minimally invasive mitral valve surgery. Using one four- to five-centimeter incision with special, long-shafted instruments and exposure devices, Dr. Lamelas can repair the valve without spreading the ribs or using endoscopes, endoballoons, or robots.

“No two mitral valves look the same, so we need a toolbox of techniques,” he said. “With this approach, we resect as little as possible and preserve the leaflet tissue. In many cases, a surgical repair is better than a replacement.” Dr. Lamelas said that UHealth Tower was one of only 22 U.S. hospitals in the country to receive the Mitral Valve Repair Center Award from the American Heart Association and the Mitral Valve Foundation. “The average cardiac surgeon might do five to eight mitral valves a year, while at UM we perform five to eight every week.”

Other key presentations included talks by Igor Palacios, M.D., director of interventional cardiology at Massachusetts Hospital in Boston, on “What’s Next for Mitral Valve,” and Fabio Sandoli Brito, M.D., Ph.D., interventional cardiologist with Hospital Sirio Libanés in Sao Paulo Brazil, on “TAVR in Rheumatic Aortic Stenosis” and “Percutaneous Single Access Subclavian TAVR.” Santiago Garcia, M.D., a former Harrington Internal Medicine Resident and now Chief of Structural Heart Disease at The Christ Hospital in Cincinnati, presented his work on modification of aortic valve replacement within a previous surgical aortic valve.

Sudden Cardiac Death Symposium

Citing the recent case of a young pro football player who collapsed on the field, Dr. Mitrani noted the importance of identifying high-risk individuals as he opened the Sudden Cardiac Death Symposium on Friday. In the session, Dr. Mitrani co-led a panel discussion on what clinicians need to know about patients with channelopathies that can cause SCD. He also paid tribute to Dr. Myerburg’s decades of contributions to population research, cellular research, and defibrillator technology. “It’s great that the trainees at Miami Valves can ask Dr. Myerburg’s advice on their cases and research projects,” Dr. Mitrani said.

During the session, Jeffrey Goldberger, M.D., professor of cardiovascular medicine, spoke on “Risk Stratification for SCD: Can We Predict the Future?” That was followed by a presentation on “Cell-based Therapy for Patients With Heart Failure: Implications for Ventricular Arrhythmias and SCD” by Joshua Hare, M.D., the Louis Lemberg Professor of Medicine in cardiology; director, Donald Soffer Endowed Program in Regenerative Medicine; senior associate dean for experimental and cellular therapeutics; and director, Interdisciplinary Stem Cell Institute.

“Using mesenchymal stem cells [MSCs], we are trying to address the problem of ventricular injury and remodeling,” said Dr. Hare. “That includes removing the fibrosis of the scar, restoring contractile tissue, and creating new cardiac myocytes.” He said that cardiologists’ concerns about arrhythmias in patients with engrafted stem cells don’t arise when using MSCs that release proteins and growth factors that encourage damaged tissues to heal themselves.

Heart Failure Symposium

Dr. Grazette led Thursday’s Heart Failure Symposium and gave a “Cardiac Recovery and Remission” presentation.

“This year’s Heart Failure Symposium focused on the evolving management of cardiogenic shock and the increased use of devices in the management of heart failure in general and cardiogenic shock in particular,” said Dr. Grazette. “Our featured speakers, a multidisciplinary group including academic thought leaders, physician-scientists, highly engaged clinicians, and trainees, provided dynamic content that provided a great exchange of ideas.”

Later in the session, cardiology fellow Miguel Martillo Correa, M.D., led a panel discussion of challenging heart failure cases, and Dr. Hare spoke on “30 Years of Heart Failure Therapy,” outlining the advances through the decades as well as the challenges for the field.

Percutaneous Intervention (PCI) Symposium

On Saturday, attendees of the PCI symposium covered a range of cardiac care issues and challenges. Drawing on his deep experience in treating patients with disease of branched heart arteries (bifurcations), Dr. Chatzizisis spoke on “Optimizing Bifurcation Left Main PCI Strategy and Outcomes.” In this challenging field, he cited the importance of three factors: the patient’s coronary anatomy, stent design, and stenting technique. “You need pre-procedure planning, including imaging,” he said. “Artificial intelligence, virtual reality, and other digital technologies can help integrate the anatomy and physiology, leading to good clinical outcomes for individual patients.”

Using PCI to treat patients with chronic total occlusion (CTO) of the coronary arteries was the topic of a presentation by Carlos Alfonso, M.D., associate professor of medicine and medical director of the Miller School’s CTO and PCI program. Asking the question, “CTO Intervention: Is It Worth the Effort?” Dr. Alfonso noted that successful procedures can provide clear benefits for patients with symptoms, such as improved quality of life and lower risk of congestive heart failure. Noting that the procedural success rate is much higher in higher-volume programs, he said, “CTO PCI is definitely worth it for the right patients — those with symptomatic coronary disease.”

Tags: Department of Medicine, Division of Cardiovascular Medicine, Dr. Eduardo de Marchena, International Medicine Institute, Latin American Society of Interventional Cardiology, Miami Valves 2023, WIlliam J. Harrington Medical Training Program