TCTMD’s Top 10 Most Popular Stories for February 2016

On-the-job hazards for physicians working in the cath lab proved to be the most popular news topic on TCTMD this month. Transcatheter valve replacement—both aortic and mitral—was the focus of several other stories on our top 10 list, accompanied by everything from left atrial appendage closure to renal denervation and the final step in Robert Califf’s winding road to FDA commissioner. 

In case you missed them, here are the most popular stories on TCTMD for February 2016. 

Tumors, Bad Backs, and Cataracts: Interventional Physicians Face a Lifetime of Risk

Many physicians might not want to spend too much time thinking about them, but the hazards of the catheterization laboratory can no longer be ignored. At ISET 2016, experts from interventional cardiology, radiology, endovascular surgery, and beyond discussed the injuries that, at best, slow down working physicians and, at worst, force an early retirement.  

Early Results for Transcatheter Mitral Valve Replacement Reveal Complications and Challenges for the Long Road Ahead

CRT 2016 offered up some early results from a handful of different transcatheter devices being developed for full mitral valve replacement, including some daunting rates of death and complications. Experts there agreed that many of the hard-earned lessons in percutaneous aortic valve replacement won’t necessarily translate smoothly into the mitral space, where competition to bring the first device to market has been fierce. 

 Future of Renal Denervation May Hinge on a Handful of Small Studies

This field has been on hold while investigators await the results of a few small trials incorporating lessons learned from SYMPLICITY HTN-3. Some experts remain confident, however, that the right adjustments have been made to ensure success in treating hypertension and potentially other diseases involving sympathetic hyperactivity.

Co-existing Left Main Disease Should Not Rule Out TAVR

Increasing operator comfortability with both left main stenting and transcatheter aortic valve procedures, as well as better understanding of the factors that predispose patients to coronary occlusion, have helped lead to fewer complications in patients with both left main disease and aortic stenosis.

Underuse of Echocardiography, Particularly in Acute MI, Linked to More In-hospital Deaths

Despite mounting use of echocardiography in the United States—leading to concerns the modality may be overused—numbers from the Nationwide Inpatient Sample suggest that echo is actually underused in a number of guideline-recommended settings, including acute MI. 

 Radial Artery Occlusion After Transradial Interventions Common but Manageable

Occlusion of the radial artery is a fairly common occurrence after transradial interventions, and given the frequency at which the complication occurs, researchers are reminding physicians about the importance of assessing arterial patency and taking steps to ensure the artery remains open.  

 Cardiologist Robert Califf Becomes New Commissioner of the FDA

The US Senate voted 88 to 4 in favor of confirming Califf, 64, a cardiologist and clinical researcher, as the 22nd Commissioner of the US Food and Drug Administration. The news caps months of sometimes contentious debate.

 ROCKET AF Investigators: Problems With Warfarin Monitoring Device Did Not Skew Results

The possibility of skewed INR findings has focused attention on whether the trial results can still be considered valid and has put heat on the ROCKET AF leaders, who became aware of the issue last October. Now trial investigators say any potential problems with the point-of-care device used to monitor warfarin in the study did not appear to have a meaningful impact on the results.

 Subclinical Changes in Valve Hemodynamics Observed in TAVR Patients

Clinical outcomes with TAVR have been very reassuring, but recent reports show increases in transvalvular gradient over time, with 4-dimensional CT data highlighting hemodynamically subclinical reduced leaflet function. The current analysis sought to assess study changes at the “echocardiographic and subclinical” level.

Final CMS Decision Memo for Watchman Dumps Controversial Warfarin Contraindication

In what may prove to be the removal of a key barrier to the expanded use of the Watchman left atrial appendage closure device in patients with nonvalvular atrial fibrillation, the Centers for Medicare & Medicaid Services has backed off on a number of controversial criteria it had initially proposed as essential in order for device implantation to be covered.

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You may also want to take a look at these TCTMD exclusives:


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Finally, TCTMD reporters have been busy at conferences all month. Check out Michael O’Riordan’s coverage of the International Symposium on Endovascular Therapies (ISET), Todd Neale’s stories from the International Stroke Conference (ISC), and my own work from the Cardiovascular Research Technologies (CRT) meeting, which wrapped up last week.


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