Editor's note: From May 6 to 9, 2021, the 19th China Intervening Congress on Cardiology (CIT 2021 Online) was held online in a grand manner. The conference forms covered the opening ceremony, the meeting of all congress partners, the latest clinical trials and surgical rebroadcast, and other contents. Experts and scholars from the global cardiovascular field gathered in the cloud to explore academic progress. Professor Gustavo Samaja from formosa general hospital, argentina is specially invited to give an interview on interventional therapy-related issues for patients with complex, high-risk and indication for interventional therapy (CHIP).
《International Circulation》: There are more and more Complex Higher-risk and Indicated Patients with coronary atherosclerotic heart disease for interventional therapy, and they often have CTO lesions, which puts forward higher requirements for interventional therapy. How to optimize the calcified lesions PCI? Would you please share us your opinion？
Professor Gustavo Samaja: I think that for higher risk patients, the correct approach is to see the entire picture. It is a bad idea to focus only on if the patient has or has not a CTO. You should consider the risk of the patient, the benefit expected for your intervention, the chance of having success of the intervention itself, and the chance of having success in your center with your resources and skills. And, after that, you should take the decision.
《International Circulation》: When can we leave a CTO Untreated?
Professor Gustavo Samaja: We can leave a CTO untreated when the risk of the intervention is bigger than your expected benefit. About that, let me share with you some talk from the Tao Te Ching, the classical book: “Act without action.” Sometimes it's best to do nothing, which means medical treatment. If the patient is a low risk patient with no angina, with no problem in everyday life, it is hard to improve his quality of life because it's already good. And if the patient is a higher risk patient, but your intervention will not add benefit on survival, I think that the best idea is to do nothing—as Laozi said a long time ago.
《International Circulation》: What do you think about the application of ELCA in CHIP PCI?
Professor Gustavo Samaja: I think it is a good tool. Unfortunately, in my country, with low resources—we don't have the resources of the developed world—we don't use it. But, I think that I can't deny that it's a good tool. I'm not sure about the situation in higher risk patients because the procedure itself is time consuming, it's contrast consuming, and the risk is higher than the risk if you prep for a classical CTO recanalization in antegrade or retrograde wave. So, I will say that it's a good tool. You should keep this tool in mind when you can.
《International Circulation》: At present, what are the main focus of interventional therapy research for CHIP?
Professor Gustavo Samaja: I think that the main focus is to analyze which is the best patient for being treated. And considering that, you should keep in mind that CHIP is not only about the cath lab. CHIP is about the preparation of the patient. It's about the procedure itself, of course, but it is really important in this group of patients—the post-operative daycare of the patient. I mean, if you add the best interventional cardiologists in the world and you do magic in the cath lab, but after the procedure you don't have a good care of the patient, in the cases of CHIP patients, the patient will pay a high price for this mistake.
Comments
Post a Comment