TAVR’s chance to improve safety

Proponents of transcatheter aortic valve replacement (TAVR) have taken lessons from others to orchestrate careful rollouts in Europe and the U.S. That cautious attitude could extend to other aspects of TAVR as well.

PCI has been around for nearly three decades. Everything has improved since its inception: the stents, the drugs, the imaging techniques, the safety protocols and outcomes. Yet concerns about radiation exposure—particularly for the operators and staff who always are present in catheterization labs—generally have lagged until recently.

Most if not all labs have heeded the call for “as low as reasonably achievable,” an effort to find a balance between getting the required image quality and reducing a patient’s radiation risks. Shielding, aprons, glasses and other items help to protect physicians and staff, and the imaging equipment and other tools now offer many features that minimize potential radiation exposure.

Still, some operators choose not to wear dosimeters, for instance, or to modify practices that could reduce their exposure further. The realization that long-term exposure might have health consequences has percolated to the surface but there is still room for improvement.

TAVR also requires imaging to help guide procedures. For several years the focus has been on outcomes in patients with severe aortic stenosis who undergo TAVR procedures. Trials started with inoperable and then high-risk patients, and TAVR for those populations is now approved in the U.S. and Europe. The next frontier is intermediate- and low-risk patients.

That means more potential TAVRs and more potential radiation exposure. As reported in the June issue of Catheterization and Coronary Interventions, a team in Northern Ireland has put radiation reduction on its front burner. They reported that they reduced radiation dose during TAVRs by 27 percent at their institution without compromising image quality or workflow.

The use of modified imaging settings is now their standard practice. Their research illustrates that awareness and opportunity exist on a small scale, and when the two are combined, it makes a difference.

Of course, their hospital is one of hundreds of TAVR programs worldwide and their protocol might not work for the TAVR community as a whole. TAVR, which has embraced models such as the heart team to facilitate its success, is positioned to be proactive by developing standardized and universal radiation reduction strategies. Why wait?    

Candace Stuart

Editor, Cardiovascular Business