TCT: Cath lab staff must integrate, not separate

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SAN FRANCISCO—As newer, more expansive procedures such as transcatheter aortic valve implementation (TAVI) emerge, it will be imperative for cath labs to integrate and establish multidisciplinary teams rather than face off in turf battles, Sam Radhakrishnan, MD, said during a presentation Nov. 10 at the 23rd annual Transcatheter Cardiovascular Therapeutics (TCT) conference.

In this new era, “a multidisciplinary team approach is important, but most importantly you must have true collaboration,” Radhakrishnan, an interventional cardiologist from the Schulich Heart Center, Sunnybrook Hospital in Toronto, offered.

“You have to have a collaboration of multiple, dedicated individuals,” he noted. The team should include interventionalists, cardiac surgeons, endovascular specialists, imaging, cardiac anesthetists, cath lab nurses, surgical scrub RNs, administration and industry clinical specialists.

“You can’t embark on these programs [like TAVI] without true collaboration with cardiac surgeons,” Radhakrishnan noted. “There is no substitute for the wisdom of an experienced surgeon in making legitimate clinical decisions.” He commended surgeons by saying they may be much more experienced than cardiologists with the after care of patients.

Because a multitude of factors must be taken into consideration—image acquisition, patient safety and testing ways to deliver the lowest radiation possible—it is imperative to structure a team that can cover and excel at all these skill sets.

For TAVI, Radhakrishnan said that surgical colleagues will now need to be trained alongside their interventional colleagues.

Endovascular specialists are also an important part of the mix because of their experience in patient selection and expertise in vascular access. “They have the ability to manage the vascular complications that can occur,” he said.

He said that anesthesiologists are also an important part of the team and can provide flexibility in scheduling.

The bottom line, however, is that “the mix you choose has to be a dedicated group,” Radhakrishnan noted.

In sum, Radhakrishnan said: “For avoiding a mess and perhaps coming more to my utopian view of these technologies and new procedures and new labs, the key element of integration success is achieved on the basis of a collaborative approach, and the philosophy of shared common goals has to extend to care delivery."