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June 25th 2008
Following a period of review and consultation with the relevant specialist societies, NICE have today issued preliminary guidance on the application of transcatheter aortic valve implantation for aortic stenosis. Full details are available via the NICE website
and PDF copies of the summary documents for clinicians and patients are available here.

Key points include:
• NICE supports the use of the intervention for patients in England and Wales with aortic stenosis who are at high risk for conventional surgery.
• Clinicians wishing to use this procedure should do so only with special arrangements for clinical governance, consent and for audit or research.
• Patient selection should be carried out by a multidisciplinary team including an interventional cardiologist, a cardiac surgeon and a cardiac anaesthetist.
• Units undertaking this procedure should have both cardiac and vascular surgical support for emergency treatment of complications.
• Ensure that patients understand the uncertainty about the procedure’s long-term efficacy and its risks, which include death and the potential need for emergency cardiac surgery.
• Clinicians should enter details of all patients undergoing transcatheter aortic valve implantation into a national database to allow ongoing evaluation of the procedure. BCIS is currently working with NICE and CCAD to develop an appropriate mechanism.
• NICE did not distinguish between the two currently available devices (Edwards-Sapien & CoreValve).
• Cost-effectiveness analyses have not yet been considered by NICE, but it is hoped that their positive preliminary comments will encourage national funding via PCTs and local networks.

Dr Bernard Prendergast
BCIS Honorary Secretary

There needs to be a further minor change to the current BCIS-CCAD dataset version 5.3.3, which will update it to version 5.4.3. Two further fields are needed:

Additional field 1.
The Healthcare Commission require that Trusts provide a single performance indicator for the treatment of patients with ST elevation MI by PCI. This will be ‘Call to Balloon’ time, interpreted to mean ‘call to first device time’, whether that device be a balloon, or for example an extraction or aspiration device. The principle is that they wish to capture the entire patient’s experience from seeking help to getting treatment. This is analogous to the ‘Call to Needle’ time for thrombolysis.

In order to deliver this, we need to add a single additional date/time field to the BCIS minimum dataset – that is ‘Call time’

Additional field 2.
In addition, in order to help track the patient journey between 2 centres, to cross-link with the MINAP dataset, we need to add the referring hospital to the dataset.

Full document and Update Options

Avoiding conflicts of interest.

Following an anonymous letter to the Minister for State that was passed on to the British Cardiovascular Society, a series of discussions has taken place regarding the issues surrounding patient confidentiality and the presence of marketing staff from technology industries in cath labs.

The BCS has produced guidance on this matter. This clearly differentiates between representatives who are present for marketing purposes and clinical specialists that are integral to a specific procedure. This guidance has been approved by the Councils of both the BCIS and the BCS. It is available in downloadable form.

Mark De Belder
BCIS President

As many of you will know, the British Cardiac Society changed its name recently to the British Cardiovascular Society to represent the fact that its members included clinicians and researchers who were involved in the entire vascular system. Similarly, interventional cardiology has developed enormously over the last decade. Not only are interventional clinicians beginning to take on work outside of the heart, but the field of intervention for structural heart disease has come of age and is rapidly expanding. Moreover, BCIS feels that it is important to reach out to other professional societies who are also involved in interventional treatments in the entire vascular system, as we have many shared problems and challenges, and have much to learn from each other. Accordingly, BCIS Council has agreed that it is now time to change the name of our major UK meeting from “Advanced Angioplasty” to “Advanced Cardiovascular Intervention”. We have already registered a new website address and have set up a link to this from the BCIS website. Plans for “Advanced Cardiovascular Intervention 2009” are already well underway and details will be posted as soon as possible. Put the dates in your diary though – Wednesday 28th – Friday 30Th January 2009. We look forward to seeing you there.

Mark de Belder
President

Martyn Thomas’ last act as President was to preside over a very successful Advanced Angioplasty 2008 meeting (January 24th & 25th), held at the London Hilton Metropole Hotel and incorporating the ‘Left Main 6+’ meeting on Wednesday January 23rd.

This year’s two key visitors were Marty Leon (Cardiovascular Research Foundation, Columbia University, New York) and William Wijns (Cardiovascular Center, Aalst, Belgium, and current President of EAPCI - the European Association for Percutaneous Coronary Intervention). Dr Leon was kind enough to also be a panellist for each of the 5 live cases shown on the Left Main 6+ course.

The Left Main course was organised by Simon Redwood and the cases transmitted from St Thomas’ Hospital.

Full Story (find out who won the Best Case Award)

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