Renowned leaders in cardiovascular research and clinical care shared their knowledge and experiences at Miami Valves 2024, the 10^th annual international structural cardiology conference hosted by the International Medicine Institute of the University of Miami Miller School of Medicine.

“Interventional and structural cardiologists are doing miraculous things to treat a variety of diseases,” said Miami Valves Director Eduardo de Marchena, M.D., professor of cardiovascular medicine and associate dean for international medicine at the Miller School. “It’s exciting to get leaders in their fields who share and discuss their research on what can be done to treat complex cases, while always thinking about what comes next.”

International Array of Cardiology Experts

More than 380 professionals from the U.S., Canada, Latin America and Europe attended Miami Valves 2024. The conference was endorsed by the Latin American Society of Interventional Cardiology (SOLACI) and supported by a dozen exhibitors and several unrestricted educational grants, including one from UHealth—University of Miami Health System.

“This is an amazing conference,” said Yiannis S. Chatzizisis, M.D., Ph.D., professor and chief of cardiovascular medicine at the Miller School. “This is a unique opportunity for professionals to see the latest and most-innovative therapies and devices in structural heart and coronary artery disease to help us achieve better outcomes for our patients. It’s also a great teaching opportunity, as our fellows learn how to tackle challenging cases while expanding their networks.”

The conference featured:

• More than 90 presentations and 60 abstracts
• A three-day main program on advances in structural heart disease
• Symposiums on advances in percutaneous coronary intervention and nursing care
• Workshops on complex electrophysiology cardiac imaging and advanced heart failure
• Hands-on workshops on pulmonary embolism catheter care
• How-to training on several devices

“As a cardiac surgeon, I want to understand the advances in interventional and imaging cardiology,” said Joseph Lamelas, M.D., professor and chief of cardiothoracic surgery at the Miller School. “Our patients benefit from a collaborative approach that incorporates advances in our fields.”

John Lasala, M.D., Ph.D., a renowned interventional cardiology and structural heart disease specialist at Washington University School of Medicine in St. Louis, was honored with the 2024 Miami Valves Lifetime Achievement Award in recognition of his research, clinical and teaching accomplishments. He gave a presentation on his 34-year career, “From Utility Baseball Player to Structural Interventionalist: A Life’s Journey,” adding that he still enjoys sports and is a consultant to the St. Louis Cardinals and St. Louis Rams.

“Miami Valves is a great way to catch up on what’s happening with valvular disease,” he added. “It’s large enough to get the latest information yet small enough that you can talk individually with other professionals.” 

Advances in Transcatheter Aortic Valve Replacement (TAVR)

Dr. de Marchena kicked off Miami Valves 2024 with a recap of recent advancements in transcatheter aortic valve replacement (TAVR) as well as other interventional procedures.

“We have seen an explosion in TAVR, which now accounts for 62% of all aortic valve replacement procedures and is being performed in over 800 U.S. centers,” he said. “Cerebral protection devices may reduce the risk of stroke, and we use them in about 60% of cases here, far more than the national average.”

Other advances include the incorporation of tissue technology to block calcium buildups as well as new aortic and mitral valves.

“Tricuspid was once the forgotten valve but now is being approached with many transcatheter technologies, and important trials are underway,” said Dr. de Marchena. “On February 2, during our meeting, the first transcatheter valve for the tricuspid valve was approved by the U.S. Food and Drug Administration. We are hoping for many more approvals in the coming years.”  

Eberhard Grube, M.D., from University Hospital Bonn, Germany, said there will be accelerated innovation of TAVR platforms and accessory devices, including aortic valve remodeling technology. He added that clinicians may need to treat moderate aortic stenosis before damage occurs to other areas of the heart.

“For lifetime management of aortic disease, the patient needs to be part of the discussion,” Dr. Grube said. “Our goal is to achieve the promise of one valve replacement for life.”

Additional highlights from the conference included:

• Saibal Kar, M.D., director of structural heart disease interventions and clinical research at Los Robles Health System, giving a video lecture on advances in transcatheter edge-to-edge repair devices
• Nicolas Van Mieghem, M.D., Ph.D. director of interventional cardiology, Erasmus University Medical Center, Rotterdam, talking about “TAVR and the Young,” referring to patients younger than 75. “TAVR should be the first choice for these aortic stenosis patients, who tend to be low risk,” he said. “This is the next frontier of TAVR and it’s very exciting.”
• Presenters from Latin America including Fábio de Brito, Jr., M.D., Ph.D., from University of São Paulo Medical School in Brazil, relaying the case of a 77-year-old woman who was treated with an investigational valve for severe aortic stenosis before participating in a SOLACI discussion on the “Best Cases from the Americas.”

Treating Mitral Annular Calcification (MAC)

Renu Virmani, M.D., president of the CVPath Institute, gave a presentation on mitral annular calcification, noting that the incidence was greater in women than men.

“MAC goes hand-in-hand with renal disease, and it is not an easy condition to treat surgically,” she said.

Following her talk, Dr. Lamelas spoke on surgical approaches to MAC, which has been identified in two, 3,000-year-old Egyptian mummies. He outlined options for repairing or replacing the mitral valve in the presence of significant invasion of calcium.

“Imaging is very important to determine the extent of calcium involvement,” he said. “Current recommendations call for these patients to be treated by surgeons who perform more than 50 mitral valve cases a year. We are proud that our university is one of the 22 mitral valve repair reference centers in the United States.”

Cardiovascular Medicine Symposiums, Workshops and Sessions

Carlos E. Alfonso, M.D., associate professor of cardiovascular medicine and medical director of the Miller School’s Advanced PCI and CTO Program, moderated the PCI symposium and discussed highly specialized techniques to treat complex coronary CTO (chronic total occlusion).

“We had a great session with experts discussing complex PCI and CTO procedures,” Dr. Alfonso said. “During the complete PCI symposium, we covered the spectrum of coronary disease, discussing a variety of topics including strategies and emerging technology for treatment of acute myocardial infarction and cardiogenic shock, as well as non-occlusive coronary disease.”

In his presentation and workshop on optimizing coronary bifurcation disease interventions, Dr. Chatzizisis said optimal outcomes involve careful imaging of the patient’s anatomy, stent design and stent techniques.

“Computer simulations and artificial intelligence have the potential to help us plan our procedures, improve outcomes and lower overall health care costs,” he said. “They can also help our trainees master their interventional skills.”

Michael Dyal, M.D., Miller School assistant professor of medicine, discussed how intravascular ultrasound imaging can help guide PCI interventions, and Nikolas Spilias, M.D., Miller School assistant professor of interventional cardiology, spoke about when and why complete coronary revascularization should be performed.

In a separate session, Drs. Chatzizisis and Spilias were joined by Maria Delgado-Lelievre, M.D., founder and director of the Comprehensive Hypertension Center, in a discussion of new renal denervation interventions that decrease hypertension by ablating the arterial nerves near the kidneys.

“This is a safe procedure with an ‘always on’ effect on lowering blood pressure,” said Dr. Spilias.

Heart Failure and Electrophysiology

Assistive devices are helping patients with heart failure when medical therapy isn’t enough, according to Luanda Grazette, M.D., associate professor of clinical medicine at the Miller School and director of the UHealth Advanced Heart Failure Program. She moderated a Thursday workshop on heart failure.

“We have come a long way with medications in three decades, adding years of life to older patients with heart failure,” she said. “Even though drugs do a great job in improving survival, they can hit a ceiling, where assistive devices are needed.”

On Friday, Jeffrey Goldberger, M.D., professor of medicine, moderated a workshop on cardiac electrophysiology with Raul D. Mitrani, M.D., professor of clinical medicine and director of clinical cardiac electrophysiology; Litsa Lambrakos, M.D., assistant professor of medicine and Alex Velasquez, M.D., assistant professor of medicine, all from the Miller School.

Dr. Mitrani said the workshop highlighted important advancements in the field of cardiac electrophysiology.

“Participants learned about new extravascular defibrillators and the advantages of physiologic pacing,” he said. “The importance of risk-factor modification, including research from UHealth, was emphasized.”

“In keeping with the theme of the conference, the EP symposium focused on the novel approaches to atrial fibrillation ablation and pacemaker/defibrillator device implantation,” added Dr. Goldberger.

He presented leading-edge Miller School research showing how stagnant catheter ablation therapy for atrial fibrillation can be dramatically impacted by the new paradigm of adjunctive medical therapy with GLP-1 agonists, a popular novel drug therapy approved for diabetes and weight loss.

Nursing and New Cardiovascular Innovations Symposiums

Stephanie Moss, D.N.P., A.P.R.N., UHealth executive director, clinical operations, and Shay Lamelas, A.P.R.N., UHealth nurse practitioner, moderated the Nursing Symposium on Saturday.

“When treating heart diseases, post-operative care is essential for good outcomes,” said Lamelas. “Our nursing team supports surgical and interventional treatments, so patients can continue to survive and thrive.”

Moss, who spoke on technological advances in heart failure, said panelists and attendees were highly engaged during the workshop.

“There was also a strong effort into fostering inclusivity and diversity at the conference, and the opportunity to network was invaluable,” she added. 

On the last day of the conference, Dr. de Marchena led a morning symposium on new investigational devices for the treatment of valvular and coronary disease. The three-hour session featured 16 presentations on devices being studied from all over the world, including two developed by Miller School cardiology faculty.

Finally, a panel heard oral presentations and recognized the conference’s abstracts. The 25 best abstracts will be published in the journal, US Cardiology Review.

Tags: cardiology, cardiovascular, Cardiovascular Division, Dr. Alex Velasquez, Dr. Carlos Alfonso, Dr. Eduardo de Marchena, Dr. Jeffrey Goldberger, Dr. Joseph Lamelas, Dr. Litsa Lambrakos, Dr. Luanda Grazette, Dr. Maria Delgado-Lelievre, Dr. Michael Dyal, Dr. Raul Mitrani, Dr. Yiannis Chatzizisis, Miami Valves 2024