番茄社区

番茄社区 asked interventional cardiologists what will be the biggest issues in their field in 2018. It will be a rich year in many areas, apparently, as they predicted new developments ranging from the structural sphere to secondary prevention.

"For me, it will be the controversy surrounding public reporting of performance/quality outcomes," said Ajay Kirtane, MD, SM, of New York-Presbyterian/Columbia University Medical Center.

Two large trials expected to be presented this year, GLOBAL Leaders and TWILIGHT, may help elucidate whether post-PCI anti-thrombotic therapy can be simplified by dropping aspirin. "Hopefully we will then better understand if the third-generation DES [drug-eluting stents] are good enough to [move from] DAPT to mono-therapy," said Magnus Ohman, MD, of Duke University Medical Center in Durham, North Carolina.

"From a pharmacology stand point, the community will finally appraise the limits of aspirin as secondary prevention regimen," agreed Marco Valgimigli, MD, PhD, of Switzerland's Inselspital Universitätsspital Bern. Additionally, in the aftermath of Absorb's retreat from the market, the community will rethink about the limits of bioresorbable technology. "I think the issues are a class effect," he said.

Ted Feldman, MD, of Evanston Hospital in Illinois, noted that two large randomized trials comparing medical therapy with percutaneous mitral repair for functional mitral regurgitation will be reported this year. "These trials will have enormous impact and will define the direction of all of the treatment options (surgery, catheter mitral replacement, and all of the types of percutaneous mitral repair) for the next several years," he continued.

"Additionally, with the emergence of percutaneous mitral annuloplasty, it will be interesting to see which patient cohort will be ideal for that strategy compared to percutaneous valve repair or replacement," said Richard Smalling, MD, PhD, of UTHealth and Memorial Hermann Heart and Vascular Institute in Houston. He added that the "rapid evolution of percutaneously delivered valves for mitral replacement will also be fascinating to watch, particularly as the new generations of mitral clipping devices are evaluated."

Also to watch out for in the structural domain is the adoption of transcatheter aortic valve treatment in place of surgery in broader patient and provider settings, according to Laura Mauri, MD, MSc, of Brigham and Women's Hospital in Boston. "This is a scientific issue – of comparing results with surgery in 'low surgical risk populations' and gaining better understanding of long-term durability relative to surgery in studies underway now -- but also a broader healthcare delivery issue of determining how patients can be provided safe and appropriate access to these procedures when it is already expected to be beneficial based on randomized trials."

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