EuroPCR 2014 Showcases Technological Advances In Complex Cardiovascular Interventions
Joint EHRA-EAPCI session provided perspective on new technological developments
St Jude Medical’s Nanostim device and Medtronic’s Micra, both single-chamber leadless pacing systems, and the most advanced commercially available valve, the Edwards Sapien 3 Transcatheter Heart Valve (Edwards Life Sciences) featured in the discussions.
With regard to leadless pacing, participants heard that there was a need for a novel system that provides reliable pacing and sensing, and addresses the challenges of current pacing systems by minimising the risks of infection, pneumothorax, dislodgement and long-term infection.
Prof Panos Vardas, University Hospital of Crete, Greece, President of the ESC and a past President of EHRA, said: “The two different technologies, leadless pacemakers and the new generation valves, reflect the progress seen within interventional cardiology and electrophysiology. In the case of the leadless pacemaker, advances in the longevity of the battery of the devices, which are now expected to last seven to ten years, have been a most important advancement.”
Prof Karl Heinz Kuck, St George hospital, Hamburg, Germany, and President of EHRA, then commented on a video demonstrating the implantation of the leadless technology and informed delegates about the status of the early clinical evidence in the field of leadless pacing.
Kuck said: “The technical advancement with leadless pacemakers represents ‘a big step forward’. These devices have the advantage of a reduced risk of infection and also a significantly lower risk of thromboembolic complications that may lead to pulmonary hypertension. The only uncertainties that we currently face are due to the fact that the experience with the device is still rather limited, and we are yet to identify the best position to have a safe implantation. My personal view is that we need better imaging technology during the implant to guarantee that the device goes to the septum and not to the free wall,” Kuck said.
Vardas added, “Leadless pacing is a very significant development, but to take it from the current VVIR configuration to the next stage of double-chamber pacing is going to be a challenge. Also, we need longer follow-up, and a better understanding of the thrombogenicity of the devices and possible complications, but I am optimistic that progress is underway.”
Trancatheter aortic heart valve developments
Participants also saw an interactive live transmission from Prof Stephan Windecker and team, from Bern University Hospital, Bern, Switzerland, of a complete implantation of the Edwards Sapien 3 valve in approximately 40 minutes. The expert panel noted that advancements in valve technology had significantly impacted the incidence of severe paravalvular leak with no reported cases of severe leak with these devices.