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Learn Francesco Maisano's Techniques for Percutaneous Heart Valve Treatment
- 1. How to learn the techniques Francesco Maisano San Raffaele Scientific Institute and University Hospital Milano
- 6. Surgery Hwy Cardiology Hwy TAVI Hwy
- 12. No major aircraft company today launches a new aircraft without simultaneously contracting for a suite of simulation devices.
- 13. Simulation: learning the basics – Hands-on simulators and bench models
- 21. Hibrid approach using the skills from Surgery and IC
- 23. Aortic valve implant OPEN MIS PORT ACCESS TRANSCATHETER Invasiveness
- 26. MIS PORT ACCESS Right Thoracotomy With Necklines
- 29. 6 Cardiac Surgeons who adapted for the future Francesco Maisano Milano Michael Davidson Boston Eric Roselli Cleveland Mat Williams New York Grayson Wheatley Phoenix Thomas Walther Leipzig
- 34. Team up all experts
- 37. The cardiac surgeon of the future Tailored approach – the best option for the patient
- 38. The new “interventional” cardiac surgeon Francesco Maisano San Raffaele University Hospital Milano - Italy
- 44. Overlapping targets SURGERY CARDIOLOGY INVASIVENESS Off pump Port access Endoscopic Robotics Percutaneous Valve disease Peripheral stenting CPS Septal ablation ASD/VSD closure PVI
- 57. … The Greatest Risk Is Not Taking One…
Editor's Notes
- Few months ago, concomitantly on the JACC and the Journal of thoracic and cardiovascular surgery, a consensus paper on PVI stated the offical positions of the following associations: the STS, AATS and the Society of cardiovascular interventions. Interestingly, the societies agreed that: … .. The integration between cardiac surgeons and cardiologists is encouraged to facilitate cross fertilization
- In 2004 I recognized that if I still wanted to be involved in PVIs I had to incorporate in my cultural and technical background, cognitive and technical skill from interventional cardiology. So I decided to undergo crosstraining in interventional cardiology, with the specific aim of being prepared for valve interventions
- First of all let me thank Dr Vanermen who invited me to give this lecture. In the last one and a half year I underwent cross training with the specific goal of being prepared to perform percutaneuos valve interventions
- My difficult task is to derive from a personal experience some general conclusions. These are the burning issues which are relevant for surgeons willing to be involved in the clinical development of endovascular valve therapy
- Before going into the details let me disclose a consulting agreement with Edwards Lifesciences, and several let’s say dangerous relationships with the enemy…. But let’s go with my story
- Everything started in 1998 when we first suggested suggesting the possibility of perfroming the edge to edge repair percutaneously. Inn 1999, Edwards started the Milano 1 project, and we were involved to test this endvascular device with an open approach. In 2001 the Milano 2 project started, and from that time on we understood that almost anything is feasible with a catheter, it is only a matter of technology. So I entered a crosstrining program to be prepared for the first in man e2e Milano 2 repair, performed with Maurice Buchbinder in our surgical operating room in march 2005.
- Therefore, I had the priviledge of experiencing all the evolution of enduvscular valve therapy. At the same time I had the opportunity of exchanging opinions with other surgeons and I found different views on PVIs. Some surgeons feel that PVI will never work or will not affect their own practice. Other surgeons think that it is not their business, cardiologists will take it and it is another reason to fight. Both positions are generating misbelief and unwise reactions. As an example we submitted and abstract to this year EACTS reporting our endovascular e2e experience in the animal model. This abstract has been rejected, and we will not able to share with our surgical comminity our experience as surgeons involved in the field. We believe that PVIs are an opportunity for surgeons, and surgeons have to be involved. This position is also the official position of the american surgical societies
- Few months ago, concomitantly on the JACC and the Journal of thoracic and cardiovascular surgery, the STS, AATS and the Society of cardiovascular interventions published a consensus document stating that…. It appears evident that surgeons and cardiologists should team work to contribute to the evolution of PVI.
- IN the last years there has been a progressive overlapping between surgery, aiming to less invasive techniques, and interventional cardiology, bocoming more and more invasive. The two disciplines had to meet somewere: and this happened with Percutaneous Valve interventions. Although initial efforts will be directed towards team approach, probably it is time for desgning a new profession, derived from the two disciplines
- How should be the ideal valve interventionalist? He or she should have gognitive and technical skills from both surgery and interventional cardiology (think for instance to the transapical approach for aortic valve implantation). New skills involve also imaging, engineering and research. But let’s see how I envisioned this scenario
- Here is the timetable of my training
- Cath lab is the best set-up to learn basic and advanced catheter skills. I have learned the many aspects and the importance of a good vascular access, and performed some basic skills including catheterization and angiography, while I assisted in PTCA and non coronary interventions. The cath lab is an unique opportunity to learn catheter management, and to be exposed to the large inventory of material and devices. In a second step, we run some simple diagnostic procedures in the OR to assess feasigbility and reliability of such new setup. Here you see an angio performed in the OR.
- I had the priviledge of use computer simulators, they allow
- An important adjunctive tool for my training has been the bench simulator. Here you see the heart is mounted in this box, and a pump simulates the beating heart and mitral valve function. You see the device working, imaged by an endoscope. This training was useful because it was
- But most of all, I gained experience in catheter skills in the animal lab.
- Talking about transeptal, this is the…… However Transeptal is not patrimony of most interventionalists.
- Not only transeptal puncture can be facilitated by echo, but generally speaking….. Imaging is the most important enanbling technoilogy for PVI and surgeons involved in the field should be exposed to most of these technolgies
- Last but not least, the personal renovation process of incorporation of new skills is complete only if the facility and the team are renovated as well. We acquired a high level portable fluro machine, and we are in the process of acquiring a hybrid room. We renovated the inventory of the matierals. Most importantly we trained the people involved in the project, for an efficient team approach
- In conclusion, looking my past year and a half from above, The cross training is feasible but you need…. Overall it has been a great experience….. But in the future we really need to focus on standardized training pathways.
- I share this slide with Pieter Kappetein. We tried to envision how to train future surgeons. There are at least two options: On is the official training through accredited recidency or fellowships, involving one year postgraduate course in interventional surgery But very important wil be the alternative pathway to be offered to fully trained surgeons, which will include….. Both pathways should be effective in creating reliable professionals to perform percutaneous valve interventions
- In conclusion: How I envision the future interventional cardiac surgeon. All this evolution is a long jump forward and certainly implies some risks ->
- But We are ready to take these risks. If you step back in the history of our profession… you will find how many risks have been undertaken by our pioneers who developed our profession in the eraly stages. The had enthusisasm, scientific attitude, they had the strong support from the industry and from engineering, but mostly they were not afraid of the change