Interventional Cardiology Training Research Articles

Simulation training for invasive cardiovascular procedures: the Heart-SIMS-1 study

Abstract Introduction Interventional cardiology training has a long learning curve and exposes patients and clinicians to undesirable procedural risks. We aim to assess whether mentored simulation-based training with three dimensional (3D) printed models can improve the procedural skills and safety performance of beginners in coronary diagnostic procedures. Methods Twenty-nine final-year medical students from a single centre were lectured in the basic principles of invasive coronary angiography (ICA) for one-hour, and then randomized to conventional training or simulation training. Conventional training (n=15) consisted in watching a 20-minute video demonstrating all ICA steps in a 3D-printed coronary simulator. Simulation training (n=14) offered the same explanations in a hands-on training session with the 3D-printed model, in pairs, for 20 minutes. The co-primary endpoint was efficacy and safety of performing a simulated ICA in the 3D-printed simulator, installed under sterile drapes, in a conventional angiography suite. Efficacy and safety were graded by a blinded investigator using a pre-specified performance checklist, including the identification of procedural "red flags", graded 0-100%. The secondary endpoint was theoretical knowledge, assessed in a 25-question multiple-choice quiz, graded 0-100%. Results All participants completed the training and evaluation phases. Both elements of the co-primary endpoint were superior in the simulation group: efficacy score of 91.5 ± 3.8 vs 64.6 ± 8.3% and safety score 100.0 (100.0-100.0) vs 62.5 (20.8-79.2) %, p<0.001. The median number of "red flags" were 2 (1-4) in conventional and 0 (0-0) in simulation training recipients (p<0.001). Secondary endpoint was higher in simulation training: 85.7 ± 9.0 vs 76.8 ± 12.7% (p=0.039). Conclusion Mentored simulation-based training of medical students in ICA with 3D-printed models resulted in improved performance regarding efficacy, procedural safety, and theoretical knowledge.ResultsSimulation and evaluation setup

Percutaneous Valvular and Structural Heart Disease Interventions. 2024 Core Curriculum of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC.

The percutaneous treatment of structural, valvular, and non-valvular heart disease (SHD) is rapidly evolving. The Core Curriculum (CC) proposed by the EAPCI describes the knowledge, skills, and attitudes that define competency levels required by newly trained SHD interventional cardiologists (IC) and provides guidance for training centres. SHD ICs are cardiologists who have received complete interventional cardiology training. They are multidisciplinary team specialists who manage adult SHD patients from diagnosis to follow-up and perform percutaneous procedures in this area. They are competent in interpreting advanced imaging techniques and master planning software. The SHD ICs are expected to be proficient in the aortic, mitral, and tricuspid areas. They may have selective skills in either the aortic area or mitral/tricuspid areas. In this case, they must still have common transversal competencies in the aortic, mitral, and tricuspid areas. Additional SHD domain competencies are optional. Completing dedicated SHD training, aiming for full aortic, mitral, and tricuspid competencies, requires at least 18 months. For full training in the aortic area, with basic competencies in mitral/tricuspid areas, the training can be reduced to 1 year. The same is true for training in the mitral/tricuspid area, with competencies in the aortic area. The SHD IC CC promotes excellence and homogeneous training across Europe and is the cornerstone of future certifications and patient protection. It may be a reference for future CC for national associations and other SHD specialities, including imaging and cardiac surgery.

Assessing the State of Training in Congenital Interventional Cardiology: A Global Survey of Program Directors.

This study aimed to evaluate the current state of congenital interventional cardiology training worldwide, with a focus on case volumes, competency assessment, and the need for ongoing mentorship during early career stages. A survey was conducted among program directors (PDs) of congenital interventional training programs across the globe. The survey gathered data on training pathways, case volumes, types of procedures performed, trainee competency assessment, and the role of ongoing mentorship. Of the 79 PDs who completed the survey, it was observed that training pathways and case volumes varied significantly, particularly between the United States and other countries. Most PDs reported an annual laboratory case volume of >500 congenital cardiac cases, with most cases being interventional. While trainees demonstrated competency in simple procedures (diagnostic cases, simple ASD closure), complex interventions (such as patent ductus arteriosus closure in premature infants) require ongoing mentorship for graduates. PDs recommended a minimum case volume of 400 total cases for trainees, including 250 interventional cases. In addition to case volumes, assessing trainee competency was deemed important, with clinical reasoning, judgment, skillset, teamwork, and complication management being key areas of evaluation. The study highlights the variability in congenital interventional cardiology training and the need for ongoing mentorship during the early career years. External mentorship programs, facilitated by national and international societies, are proposed to provide critical support for early career interventionalists thus enhancing patient care for congenital heart disease. Ultimately, the findings of this survey may serve as a framework for future training standards and guidelines in this specialized field.

Three-dimensional simulation for interventional cardiology procedures: Face and content validity

Introduction and objectivesThree-dimensional (3D) model simulation provides the opportunity to manipulate real devices and learn intervention skills in a realistic, controlled, and safe environment. To ensure that simulators provide a realistic surrogate to real procedures they must undergo scientific validation. We aimed to evaluate the 3D-printed simulator SimulHeart® for face and content validity to demonstrate its value as a training tool in interventional cardiology (IC). MethodsHealth professionals were recruited from sixteen Portuguese IC units. All participants received a 30-minute theoretical introduction, 10-minute demonstration of each task and then performed the intervention on a 3D-printed simulator (SimulHeart®). Finally, a post-training questionnaire focusing on the appearance of the simulation, simulation content, and satisfaction/self-efficacy was administered. ResultsWe included 56 participants: 16 “experts” (general and interventional cardiologists), 26 “novices” (cardiology residents), and 14 nurses and allied professionals. On a five-point Likert scale, the overall mean score of face validity was 4.38±0.35 and the overall mean score of content validity was 4.69±0.32. There was no statistically significant difference in the scores provided by “experts” and “novices”. Participants reported a high level of satisfaction/self-efficacy with 60.7% considering it strongly improved their skills. The majority (82.1%) “agreed” or “strongly agreed” that after the simulation they felt confident to perform the procedure on a patient. ConclusionThe 3D-printed simulator (SimulHeart®) showed excellent face and content validity. 3D simulation may play an important role in future IC training programs. Further research is required to correlate simulator performance with clinical performance in real patients.

Changes to the editorial board: new co-editor for EHJ.

All correspondence relating to this article should be sent to cardiopulse@unicatt.it. Marco Roffi, MD, is professor of medicine, vice-chair of cardiology, and director of the Interventional Cardiology Unit at the University Hospitals of Geneva, Switzerland. Following training in interventional cardiology with Bernard Meier at the University Hospital of Bern, Switzerland, and with Eric Topol at the Cleveland Clinic, United States, he worked alongside Thomas Lüscher in Zurich, Switzerland. He has been a member of the international editorial board of EHJ since 2013 and has held a wide range of roles across the ESC working to ensure the Society’s reach, authority, and impact (Figure 1). Filippo Crea created a team of EHJ co-editors with the task of being EHJ ambassadors across the continents. The purpose is to approach cardiologists from all over the world and introduce them to the Journal. The fact that EHJ is one of the leading cardiovascular journals worldwide may be a barrier to many cardiologists, especially for the younger generation. My job as EHJ co-editor for Western Europe will be to try to reduce the barriers in this part of the world. On behalf of the EHJ leadership, I would like to take the opportunity to thank William Wijns, who preceded me in this function, for all his work.

2022 CCS/CAIC Guidelines for Training and Retraining in Adult Interventional Cardiology.

Interventional cardiology is a technical specialty that provides patient care through an integration of clinical assessment, invasive imaging–based diagnoses, and percutaneous/minimally invasive therapy for cardiovascular disease. Recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) established an updated competency-based Area of Focused Competence (AFC) within the scope of adult cardiology as a diploma-training program to provide structured training in interventional cardiology.

Pediatric and Congenital Interventional Cardiology Training

Pediatric and Congenital Interventional Cardiology Training

Perspectives of Female Cardiology Trainees on Interventional Cardiology Training and Careers: A Canadian Nationwide Survey.

Women remain distinctly under-represented in cardiology and interventional cardiology (IC) in particular. Female physicians have reported harassment and discrimination based on gender. Respecting the principles of diversity, equality and inclusivity is crucial in a modern workforce. In this nationwide survey, we aimed to investigate Canadian female resident perceptions of cardiac catheterization training and examine barriers to women pursuing a career in IC. A high perception of sexism and concerns around family were identified as potential barriers to an IC career amongst females.

ACGME Interventional Cardiology Milestones 2.0-an overview: Endorsed by the Accreditation Council for Graduate Medical Education.

This document provides an overview of the rationale, development, interpretation, and practical suggestions for implementation of the new Accreditation Council for Graduate Medical Education (ACGME) Interventional Cardiology (IC) Milestones 2.0. Previously, IC programs used the general ACGME Milestones for internal medicine. The IC Milestones version 2.0 updates the ACGME competencies to be specific to training in IC. In 2019 an ACGME working group consisting of IC program directors, a lay representative, and representatives from the American Board of Internal Medicine met to develop the IC Milestones version 2.0. The ACGME IC Milestones 2.0 establishes a framework for formative feedback for trainees within domains of patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills. The 2021 IC Milestones 2.0 provides a framework for IC mentors and trainees to identify areas for improvement or commendation help stimulate meaningful educational discussions, and provide the basis for self-reflection and self-improvement.

Transradial versus transfemoral access for cardiac catheterization: a nationwide pilot study of training preferences and expertise in The United States

BackgroundThe objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in the United States. As TRA continues to dominate the field of interventional cardiology, there is a concern that trainees may become less proficient with the femoral approach.MethodsA detailed questionnaire was sent out to academic General Cardiovascular and Interventional Cardiology training programs in the United States. Responses were sought from fellows-in-training and faculty regarding preferences and practice of TFA and TRA. Answers were analyzed for significant differences between trainees and trainers.ResultsA total of 125 respondents (75 fellows-in-training and 50 faculty) completed and returned the survey. The average grade of comfort for TFA, on a scale of 0 to 10 (10 being most comfortable), was reported to be 6 by fellows-in-training and 10 by teaching faculty (p < 0.001). TRA was the first preference in 95% of the fellows-in-training compared to 69% of teaching faculty (p 0.001). While 62% of fellows believed that they would receive the same level of training as their trainers by the time they graduate, only 35% of their trainers believed so (p 0.004).ConclusionThe shift from TFA to radial first has resulted in significant concern among cardiovascular fellows-in training and the faculty regarding training in TFA. Cardiovascular training programs must be cognizant of this issue and should devise methods to assure optimal training of fellows in gaining TFA and managing femoral access-related complications.

Simulation training in interventional cardiology using an anatomical model of the heart and main vessels «CorView»

The article discusses the possibilities of using the CorView model of the human heart with great vessels for teaching interventional cardiology, which makes teaching as close as possible to real clinical practice in the operating room.

Impact of the COVID-19 pandemic on interventional cardiology training in the United States.

ObjectivesWe sought to determine the effect of COVID‐19 related reduction in elective cardiac procedures and acute coronary syndrome presentations on interventional cardiology (IC) training.BackgroundThe COVID‐19 pandemic has significantly disrupted healthcare in the United States, including cardiovascular services. The impact of COVID‐19 on IC fellow training in the United States has not been assessed.MethodsThe Society for Cardiovascular Angiography and Interventions (SCAI) surveyed IC fellows training in both accredited and advanced non‐accredited programs, as well as their program directors (PD).ResultsResponses were received from 135 IC fellows and 152 PD. All respondents noted reductions in procedural volumes beginning in March 2020. At that time, only 43% of IC fellows had performed >250 PCI. If restrictions were lifted by May 15, 2020 78% of IC fellows believed they would perform >250 PCI, but fell to only 70% if restrictions persisted until the end of the academic year. 49% of IC fellows felt that their procedural competency was impaired by COVID‐19, while 97% of PD believed that IC fellows would be procedurally competent at the end of their training. Most IC fellows (65%) noted increased stress at work and at home, and many felt that job searches and/or existing offers were adversely affected by the pandemic.ConclusionThe COVID‐19 pandemic has substantially affected IC training in the United States, with many fellows at risk of not satisfying current program procedural requirements. These observations support a move to review current IC program requirements and develop mitigation strategies to supplement gaps in education related to reduced procedural volume.

Training in congenital interventional cardiology: interviews with experts from around the globe - part one.

The foundation of wisdom is rooted in experience, and thus we reflexively call upon our senior leaders, mentors, coaches, and family members for guidance in our personal and professional lives. Witnessing the weathered perspectives of others allows for an internal audit of one’s own strengths and deficiencies, which ultimately inspires personal growth. This experience is heightened when both the mentor and the mentee, for example, share a common goal. The field of congenital interventional cardiology, with its constant evolution and diverse technical approaches, requires a lifetime of learning, as well as safe passage of knowledge to the next generation. While there are published recommendations for what to consider when completing this task, hearing the sentiments of those with experience may be more profitable for future fellows and current interventionalists. In part one of a series, we hope to accomplish this goal by presenting an opportunity to learn from our experienced colleagues on the topic of congenital interventional cardiology training. Specifically, we aim to share expert opinions on how to succeed as a congenital interventional fellow, illustrate the diversity of teaching styles and expectations in various healthcare systems, and for the mid-career interventionalists, provide insight into the character traits of a successful mentor of interventional fellows.

Variation in Anticoagulation Practices in the Congenital Cardiac Catheterization Lab: Results of a Multinational PICES Survey.

The complex nature of congenital heart disease (CHD) has hindered the establishment of management standards for peri-catheterization anticoagulation. We sought to describe anticoagulation practice variability among providers performing cardiac catheterization in children and adults with CHD. A web-based survey ( http://www.surveymonkey.com ) was distributed to pediatric and congenital interventional cardiologists. Respondents were queried on their training, practice setting, years in practice, and case volume. Clinical questions focused on general anticoagulation strategies and on five common clinical scenarios: two diagnostic (biventricular circulation, single ventricle physiology) and three interventional cardiac catheterizations (atrial septal defect closure, pulmonary artery stenting in Fontan circulation, stent placement for coarctation of aorta). Seventy-seven pediatric and congenital interventional cardiologists responded to the survey (81% in the United States). Twenty-six (36%) worked in a public medical institution; 57% worked in a free-standing children's hospital. Twenty-six percent had been in practice for < 5years and 32% for > 15 years; 75% completed additional training in interventional congenital cardiology. The median number of cases performed was 200/year (IQR 110); median number of interventional cases was 100/year (IQR 100). Responses to general queries and specific clinical scenarios suggested significant variation in anticoagulation practices, including monitoring of anticoagulation during catheterization, protamine use, and outpatient anticoagulation after catheterization. Practices not only varied between providers but also between different clinical scenarios. Practice patterns did not correlate with provider experience or case volume. Management of anticoagulation in the congenital cardiac catheterization lab varies from operator to operator. Our study may provide some initial insight and context for discussion regarding anticoagulation in a field of increasingly heterogeneous interventional techniques and patient substrates. Future studies would be helpful to better define "best practices" for peri-procedural thromboprophylaxis in patients with congenital heart disease.

CRT-200.25 Comparison Of Time Exposed To Radiation During Interventional Cardiology Training Between Transradial And Transfemoral Access On Patients Undergoing Coronary Angiography And Interventional Procedures: Experience Of An Interventional Cardiology Training Center On A Developing Country

Few data available between transradial and transfemoral time exposure to fluoroscopy during coronary angiography (CA) and percutaneous coronary intervention (PCI) of radialists training centers. Our study retrospectively analyzed 3.235 patients who underwent to coronary angiogram and intervention

A passive beating heart setup for interventional cardiology training

Abstract Realistic training of cardiologic interventions in a heart catheter laboratory is hardly achievable with simple tools and requires animal experiments. Therefore, first a simple mock circuit connected to a porcine heart mimicking the natural heart motion was developed. In a second step the setup was duplicated to drive both sides of the heart independently to generate motion and physiologic pressures and flows. Using this simple setup cardiologic interventions (arterial and ventricular septal defects ASD/VSD closure) were performed successfully and allowed realistic training under the C-arm, echocardiography, placement of catheters and repair of ASD/VSD. With the second setup flows of up to 4 l/min were achieved in both sides of the heart at maximum left and right ventricular pressures of 80 mm Hg and 30 mm Hg respectively. This method is inexpensive and represents a realistic alternative to training in animal experiments.

Simulator Training in Interventional Cardiology

Simulator training in interventional cardiology is becoming a central part of early career acquisition of technical and non-technical skills. Its use is now mandated by national training organisations. Haptic simulators, part-task trainers, immersive environments and simulated patients can provide benchmarked, reproducible and safe opportunities for trainees to develop without exposing patients to the learning curve. However, whilst enthusiasm persists and trainee-centred evidence has been encouraging, simulation does not yet have a clear link to improved clinical outcomes. In this article we describe the range of simulation options, review the evidence for their efficacy in training and discuss the delivery of training in technical skills as well as human factor training and crisis resource management. We also review the future direction and barriers to the progression of simulation training.

Simulator Training in Interventional Cardiology.

Simulator training in interventional cardiology is becoming a central part of early career acquisition of technical and non-technical skills. Its use is now mandated by national training organisations. Haptic simulators, part-task trainers, immersive environments and simulated patients can provide benchmarked, reproducible and safe opportunities for trainees to develop without exposing patients to the learning curve. However, whilst enthusiasm persists and trainee-centred evidence has been encouraging, simulation does not yet have a clear link to improved clinical outcomes. In this article we describe the range of simulation options, review the evidence for their efficacy in training and discuss the delivery of training in technical skills as well as human factor training and crisis resource management. We also review the future direction and barriers to the progression of simulation training.

A call for SCAI members to become physician leaders.

In 2010 Robert Kocher MD painted a grim view of two possible futures 1. Both included accountable care organizations (ACOs) as key players in the United States health care system. In one version of the future, physicians took responsibility for leading ACOs, and consequently set the policies by which ACOs operated. Physicians were key decision-makers, advocated for excellent patient care, and reaped the economic benefits of efficient care rendered in the ACOs. In the other, very different vision of the future, physicians ceded control of ACOs to hospital administrators who operated their ACOs to benefit hospitals. In this vision, physicians dwindled in status, influence, and economic well-being, and patient care suffered. Kocher's message is clear: take a seat at the leadership table, or be on the menu. This paper is a call for interventional cardiologists to step up to positions of leadership to make sure that Kocher's second vision of the future does not come true. One theory of leadership holds that good leaders are good leaders because they have certain inborn traits 2. The opposing theory holds that good leadership is learned. Both are partly true. Either way, the drive and ambition required to be an interventional cardiologist makes us particularly well-suited for leadership. Most interventional cardiologists have many traits of “natural” leaders. We know how to set goals, make decisions under stress, learn and rebound from failure, and lead and inspire teams. All of these are important for successful leaders. Some leadership skills must be acquired through study, including business and financial savvy, negotiation, and knowledge of organizational behavior. But if they can be mastered by college business majors they can also be learned by physicians. Other qualities such as emotional intelligence and relationship-building, if not learned through medical or interventional cardiology training, can be picked up by aspiring leaders through hard work and a measure of humility. Interventional cardiologists are used to mastering new skills and techniques on the job; if we can learn new structural heart disease procedures we can learn how to read a financial statement or develop a strategic plan. Interventional cardiologists need to take leadership positions in health care for two reasons. The first is the welfare of our patients. As payment systems transition to “value-based”, and as health systems seek ways to make health care more efficient, no group is as well-positioned to understand threats to patients from health care reform, or to guard the interests of patients, as are physicians. Physicians have a moral obligation to lead health care organizations at all levels so as to protect the interests of their patients 2. The second reason for physicians to learn leadership is to retain control of their own fate. If you aren't leading, someone less competent may be leading you. If you aren't leading, someone with a non-patient-oriented viewpoint may lead your organization. If you aren't leading, someone else may lead you down a path of professional dissatisfaction. Academic physicians 4, surgeons 5, family practitioners 6 and heart failure physicians 7 have issued calls for their colleagues to become physician leaders. This is your call to leadership. Not only do interventional cardiologists have the same reasons as other specialists to become leaders, but interventional cardiologists are particularly well-suited to do it. Colleagues – answer this challenge, prepare yourself for leadership, and step up to leadership positions in your organizations. Thanks for critique and contribution to this article by Jeff Adams MBA, Susan Frye MBA, and Mary Stark MFA.

How Did Andreas Get Here?

![Figure][1] With the coming of the new academic year, there are always interesting questions from fellows beginning their training in interventional cardiology. I enjoy the in-depth discussion about case presentation selection for interventions, technical approaches to lesions, management