What did we learn from EST 2016?

ASD- John Thomson was clear that the volume of procedures was important- "practice makes perfect". There is no agreement on the minimum number of cases for competence. In addition, no agreement was reached over balloon sizing vs no  balloon sizing. Balloon sizing often leads to larger devices being implanted - less displacement, but perhaps more erosion? What is clear is that the lack of aortic rim was NOT a reason to refer for surgery.

PFO-Mark Turner agreed that the UK was in a tricky place with Commissioning by Evaluation. We were not clear that this process would deliver anything meaningful. Again, patients would want the procedure performed by an experienced operator.  Easy PFO closure is easy. When it gets tricky and challenging, experience counts.

PV leak- Nilesh Sutaria showed how important Imaging is. TOE is the mainstay of assessment and helping the inverventionist. He went through the range of devices. The new PLD device from Occlutech is the 1st CE marked device and has some merits, with the Amplatzer Vascular Plugs providing excellent alternatives. The AVP-4 can be passsed through a diagnostic catheter and can help in heartsink cases. The hybrid approach, with transapical access makes treatment easy, if the patient is fit for the procedure. None in the room were brave enough to try percutaneous transapical closure. Despite a wealth of experience, Oliver Omerod showed what can go wrong, especially with early experience and limited devices. Patrick Calvert shared the UK experience, and surprised us all with the fact that mortality is not as low as was thought, for these minimally invasive procedures

Congenital Interventions- covered a range of challenging cases and discussions about the choice of technology for coarctation, pulmonary valves and PDA.

Mitral Valve interventions- Mark Turner evaluated the data for the mitraclip- it is still a niche procedure in the UK, but there is no doubt that some patients benefit greatly. If TAVI is like a crossword puzzle, the Mitraclip is a tricky cryptic Sudoku. Technically challenging and needing great imaging support.

LAA closure-affected by Commissioning by Evaluation, but the data are strong, especially if usual anticoagulation is contraindicated. The Watchman and ACP devices are the now, but the future could be the Occlutech LAAO, and other new devices- the range of devices were covered.  Bushra Rana assessed the imaging needed to allow safe cases to be performed.

TAVI is an expanding procedure and lifesaving. Discussions took place with the audience about the selection of patients and minimal contrast use, and the move is towards less GA, less TOE, and fewer access lines.

Fistulas- there was a lot of experience within the participants in closing these fistulas - there was a robust discussion about WHEN to do it, as well as HOW.

You cannot afford to miss EST 2017?  Those who attended in 2016 felt that at the inaugural meeting, we had a winning formula, with a small enough audience to engage in uninhibited discussion, and with a faculty strong enough to be at any international meeting.

Iqbal Malik, Shakeel Qureshi, Mark Turner, Co-Directors

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