Interventional Cardiology

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Coronary angiography through left radial access as first line approach
  • Intravascular coronary imaging with intravascular ultrasound, (IVUS) and optical coherence tomography (OCT)
  • Functional Assessment of the severity of coronary lesions with FFR, iFR, QFR, RFR
  • Percutaneous Coronary Interventions (PCI) for: 
    • Complex coronary lesions
    • Bifurcations lesions
    • Unprotected left main coronary artery
    • Severely calcified lesions (using scoring balloons, coronary lithotripsy rotational atherectomy)
    • Chronic total occlusions (using antegrade and retrograde approach)
    • Single vessel remaining circulation 
    • Multivessel disease
  • Latest generation drug-eluting balloons for the treatment of coronary restenosis and diffuse disease
  • Primary PCI– 24 hr service
  • Percutaneous left and right ventricular assist devices
  • Transcatheter aortic valve implantation with new generation devices using minimal invasive approach and conscious sedation
  • Transcatheter valve repair or replacement in patient with mitral and tricuspid regurgitation
  • Transcatheter closure of perivalvular leaks
  • Percutaneous closure of the left atrial appendix (LAA)
  • Patent Foramen Ovale (PFO) and atrial defects closure
  • Renal artery denervation for arterial hypertension treatment Alcoholization of the interventricular septum in obstructive hypertrophic cardiomyopathy (Sigwart Procedure)
  • Peripheral angioplasty
    • Carotid
    • Renal
    • Peripheral (lower limbs, subclavian artery)

PROCEDURES PERFORMED PER YEAR:

  • Over 3,500 Coronary Angiograms  
  • 1,500 Percutaneous Coronary Interventions (PCI)
  • 263 IVUS/ 60 OCT
  • 115 FFR
  • 220 Transcatheter Aortic Valve Implantations (TAVI)
  • 120 Mitralclip
  • 66 PFO/ASD closure
  • 31 LAA
  • 55 percutaneous VAD/ 79 IABP

The Interventional Cardiology Unit is specialised in the treatment of complex coronary artery diseases with latest generation drug-eluting stents and drug eluting balloons and adjunctive imaging (IVUS and OCT) and functional (FFR, QFR, RFR) technologies and in the transcatheter treatment of valvular and structural heart diseases. The unit deals with congenital adult cardiac defects.

San Raffaele’s Interventional Cardiology unit is a high-volume centre with 3 Cath labs and 24h service for emergencies, performing more than 3,000 coronary angiograms, 1,500 Percutaneous Coronary Interventions (PCI), 300 Trans catheter Aortic Valve Implantations (TAVI) and other complex coronary and structural procedures each year. The unit constantly takes part in sponsored and investigator driven research projects and clinical trials (pre-CE mark and post marketing/observational and/or randomised) in treatment of coronary artery, valve and structural heart diseases. In addition, the unit, in collaboration with the Vita – Salute San Raffaele University, is hosting a second level University Master’s Degree in Interventional Cardiology. The course is open to EU and non-EU physicians. They are exposed to hands on training activities and to innovative clinical research projects, always tutored by a senior staff physician. The unit is also involved in teaching activities and preparation of thesis for medical students, cardiology residents from the Vita – Salute San Raffaele University, and research fellows.

treatmentS

Coronary Artery Disease

The most frequently appearing heart diseases are related to the progressive narrowing of the coronary arteries that bring oxygenated blood to the heart. Because of smoking, unhealthy eating habits, high cholesterol, diabetes, and other factors that damage the walls of the arteries, obstructions are created. They can be diagnosed through specific examinations and treated with targeted interventions. The same type of narrowing can affect different arteries such as carotid, renal and iliac / femoral.

The unit is a reference centre for patients suffering from complex coronary artery diseases: severely calcified lesions, unprotected left main, bifurcations, multi-vessel disease, chronic total occlusions. Refractory angina, despite optimal medical therapy, is also a pathology treated at the Interventional Cardiology unit in addition to non-obstructive Coronary Artery Diseases (CAD).

Main Pathologies Treated:

  • Coronary Artery Disease in the context of:
    • Stable and/or unstable angina
    • Non-ST elevation myocardial infarction (NSTEMI)
    • ST elevation myocardial infarction (STEMI)
    • Cardiogenic Shock

Top Surgical Procedures:

  • Elective and primary Percutaneous Coronary Interventions (PCI) with the newest drug eluting stents as well as bio-absorbable scaffold
  • Complex Percutaneous Coronary Interventions:
    • Complex unprotected left main and bifurcations lesions
    • Multi-vessel Percutaneous Coronary Intervention (PCI) and Chronic Total Occlusion Recanalization, anterograde and retrograde, with FFR and IVUS- OCT guidance
  • Coronary Sinus stent implantation (REDUCER) for patients with refractory angina
  • Hemodynamic percutaneous support devices in the context of protected Percutaneous Coronary Intervention (PCI) and cardiogenic shock

Valve Disease

Since the beginning of the development of trans catheter treatment of valve disease, the Unit has been involved in the development of new devices. Different devices have been investigated in the context of first-in-man pre-CE (European Conformity) marking studies, and after they became commercially available in the post-marketing studies and randomised clinical trials.

Main pathologies treated:

  • Symptomatic severe aortic stenosis in high and intermediate risk according to the heart team decision
  • Severe mitral and tricuspid regurgitation as well as para-valvular leaks

Top Surgical Procedures:

  • Trans catheter Aortic Valve Implantation (TAVI) using the latest generation prosthesis and embolic protection devices, when indicated. TAVI are delivered in conscious sedation and in the absolute majority of cases through the femoral access
  • Trans catheter mitral regurgitation repair and replacement
  • Trans catheter tricuspid regurgitation repair and replacement

Structural Heart Disease Percutaneous Procedures

The Unit also continuously performs percutaneous procedures in other structural heart diseases.

Main pathologies treated:

  • Patent Foramen Ovale (PFO)
  • Atrial Septal Defects
  • Left Atrial Appendage Closure for patients with low tolerance to oral anticoagulation

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • Optical Coherence Tomography (OCT)
  • Intravascular Ultrasound (IVUS)
  • Fractional Flow Reserve (FFR)
  • Quantitative Flow Ratio (QFR)
  • Percutaneous Left and Right Ventricular Assist Devices, microaxial miniaturized pumps, Impella, and intra aortic ballon pump