Emerging technologies in cardiac interventional care 

In recent years, cardiovascular medicine has seen significant advancements that have transformed how we diagnose and treat heart diseases. Innovations in cardiac interventional care, specifically for structural heart disease and coronary artery disease, are providing less invasive, more effective options for patients. 

Structural heart diseases are conditions affecting the heart’s valves, walls, or chambers. One of the revolutions in aortic valve disease has been Transcatheter Aortic Valve Implantation (TAVI). TAVI, also known as TAVR (Transcatheter Aortic Valve Replacement), has been a groundbreaking development in the treatment of aortic stenosis, a condition where the aortic valve becomes narrowed, obstructing blood flow from the heart to the rest of the body. Traditionally, treatment required open-heart surgery, which posed significant risks, particularly for elderly patients or those with multiple co-morbidities. TAVI is a minimally invasive procedure in which a new valve is inserted through a catheter, usually via the femoral artery in the groin, though other access points can be used as well. This new valve then takes over the function of the old, diseased valve, significantly improving blood flow and reducing symptoms. 

Rapid advancements and refinements in procedural techniques have been made over the years with TAVI. We have now been able to standardise TAVI procedures with tailored approaches based on the patient’s unique anatomy, health status and risk factors, selecting the most suitable valve type and size leading to greater efficacy, early discharge and improved long-term outcomes. 

New-generation TAVI valves feature enhanced sealing and positioning systems enhancing outcomes by reducing complications such as paravalvular leaks and extending the lifespan of the implant. Innovations in imaging technologies, such as 3-D echocardiography and CT imaging, have improved the precision of valve placement. 

Artificial Intelligence (AI) is now being integrated into imaging and navigation systems to assist in planning and executing procedures with higher accuracy. Also, brain protection filters are now available, which are temporarily placed in the arteries leading to the brain, minimising neurological complications. For patients who have already undergone surgical valve replacements and now face deterioration of their bioprosthetic valve, TAVI offers a “valve-in-valve” approach allowing the placement of a new transcatheter valve inside the existing failed bioprosthetic valve, avoiding a repeat open-heart surgery. 

Our experience, clinical trials and real-world studies have consistently demonstrated the efficacy and safety of TAVI with improved survival rates and quality of life, reinforcing its role as a standard of care for aortic stenosis and supporting its expansion to broader patient groups. 

Advancements in mitral valve therapies 

Mitral regurgitation (MR), where the mitral valve fails to close properly, allowing blood to flow backward into the heart, is another common valve disorder. Transcatheter Edge-to-Edge Repair (TEER) has emerged as a key, minimally invasive procedure valuable for patients with MR who are not suitable candidates for open-heart surgery. TEER involves the use of a device (usually Mitraclip) which is delivered via a catheter to “clip” together the leaflets of the mitral valve reducing the backward flow of blood. 

For patients with mitral valve disease not amenable to repair, Transcatheter Mitral Valve Replacement (TMVR) offers a minimally invasive option. While still in the early stages compared to TAVI, TMVR is being refined with new devices and techniques. 

Tricuspid valve therapies 

Currently, several transcatheter options are being developed to treat tricuspid valve disease. Techniques such as Tricuspid Valve Replacement and Tricuspid Valve Repair are being developed and tested. These devices and techniques aim to address tricuspid regurgitation, which can be particularly challenging to treat due to the complex anatomy of the right side of the heart. 

For patients with multiple valve issues, new hybrid approaches are being explored. For example, patients with both mitral and tricuspid regurgitation may benefit from staged or combined procedures to address both valves, improving overall heart function. 

Advancements in coronary artery disease therapies 

Coronary Artery Diseases (CAD) are caused by the narrowing of coronary arteries by plaque build-up, reducing blood flow to the heart muscle. 

CAD remains one of the leading causes of death worldwide. In addition to traditional treatments like coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI), several cutting-edge therapies are being developed to enhance the treatment of CAD. Some of these are detailed below. 

Intracoronary imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) provide high-resolution images of coronary arteries from within, allowing for precise assessment of plaque characteristics and stent placement. 

Drug-eluting balloons (DEB) are used in patients who are at high risk for restenosis after PCI. These balloons release drugs that prevent the re-narrowing of arteries. 

Bioresorbable scaffolds gradually dissolve over time and restore the natural flexibility of the blood vessel unlike traditional stents, which are permanent. Although their use is still limited, ongoing research is focusing on improving scaffold design and drug-eluting capabilities. 

For calcified plaques that are very hard and where traditional balloon angioplasty may not work, making it challenging to place stents, Intravascular Lithotripsy (IVL) or shock wave is an emerging technology that uses sound waves to break down the plaque. Orbital Atherectomy is another new modality, which uses a rotating device that sands down calcified plaque. Excimer laser employs laser energy to vapourise plaque and is effective to cross blockages that are resistant to other forms of treatment. Laser can be combined with other therapies for optimal results. 

Precision medicine and AI 

Customised treatment plans using AI algorithms can analyse patient data to predict outcomes, identify optimal treatment strategies and monitor patient progress post-intervention, potentially improving long-term outcomes. 

The field of cardiac interventional care is advancing rapidly, paving the way for more precise, less invasive treatments that are making it possible to treat heart disease more effectively with fewer complications. TAVI and TEER are already transforming the treatment landscape for valve disease, while new therapies for mitral, tricuspid valves and coronary artery disease continue to emerge. 

(Dr. G. Sengottuvelu is a senior consultant and interventional cardiologist at Apollo Hospitals, Chennai)