TCT 2023 Daily Wrap: Day of Innovation and Day 1 

Seth Bilazarian, MD, and Chuck Simonton, MD, recap Day 1 at the 2023 Transcatheter Cardiovascular Thereapeutics (TCT) conference in San Francisco, CA. The first featured highlight from Day 1 is a moderated abstract presentation from Haroon Faraz, MD, titled, “Multidisciplinary team approach to reducing vascular complications in MCS Impella® supported patients.” Examining mechanical circulatory support (MCS) experience from the past three years at Hackensack University Medical Center, Dr. Faraz highlighted dramatic improvement in vascular complication rates, attributed to a multidisciplinary team approach, early shock identification and early recognition of limb ischemia.

In an afternoon debate titled, “Is percutaneous LVAD the first-line MCS of choice for acute MI and cardiogenic shock?” Divaka Perera, MD, argued that we don’t yet have randomized controlled trial (RCT) data to answer the question while Babar Basir, MD, argued that the National Cardiogenic Shock Initiative (NCSI) protocol offers the best approach for managing acute myocardial infarction (AMI) cardiogenic shock patients while awaiting RCT data from the RECOVER IV RCT.

Dr. Bilazarian interviews Aditya Bharadwaj, MD, who presented PROTECT III data on characteristics of patients undergoing high-risk PCI. Looking at characteristics of 1,237 patients, Dr. Bharadwaj reports that  82% of the patients had all three characteristics—complex coronary anatomy, patient comorbidities and adverse hemodynamics—that make up the familiar Venn diagram of high-risk PCI patient characteristics.

Dr. Bilazarian also highlights a talk by Alexandra Lansky, MD, from Yale University, called “Safeguarding the Heart.” Dr. Lansky discussed how the NCDR CathPCI and BCIS CHIP-PCI risk scores were seemingly not applicable in Impella-treated patients and overestimated outcomes in pLVAD supported high-risk PCI in PROTECT III.

In a brief interview with Dr. Bilazarian, Prof. Norman Mangner, MD, from the Dresden Heart Center, discusses the ongoing PROTECT IV RCT. Prof. Mangner reports that the trial has currently enrolled 60% of the study population and with a three-year follow-up endpoint, results are expected in early 2026. 

Highlights from the pre-TCT Day of Innovation included a “standing room only” session on cardiogenic shock and a presentation by Nicolas Van Mieghem, MD on the five most critical clinical and technical needs in temporary MCS, including sound patient selection and best practices. Also, an Abiomed-sponsored event featured new Impella technology and interviews with physicians who have early experience with the technology.