From the March 2016 issue of HealthCare Business News magazine


Positioning of the devices in the lab is also a consideration, as more structural heart procedures are moving from hybrid ORs into the cath lab. Years ago, the hypothetical concern was that if something went wrong, the patient would need to be opened up, Maini says. Since fluoroscopy equipment was usually fixed and could not move out of the way, it made for a less sterile field. The current technologies, such as the Artis zeego fluoroscopy unit from Siemens Healthcare, which is what Maini uses, moves completely out of the way, and the cath lab tables move in multiple directions, simulating a table in the OR, he says. “If you were going to do an open procedure on that table, it is very possible,” Maini says. “That is a very important feature of any new fluoroscopy equipment that is going to be used for these procedures.”

Changes in workflow may be on the horizon. Philips recently acquired Volcano Corporation, which manufactures intravascular ultrasound systems and technology for measuring fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), and Tabaksblat says the two companies plan to work together to create products that make for a better experience in the cath lab.


For example, cardiologists use FFR to determine whether a patient needs a stent — if the measurement is below .8, it’s been proven that a stent is best for the patient, and if it is above .8, it’s better not to place a stent. Tabaksblat says that though there is very clear evidence for using FFR to decide on stent placement, the technology is underutilized, and many doctors still rely on the angiogram to determine whether or not to place a stent. Tabaksblat says this is likely because the FFR measurement is difficult to insert into the cath lab workflow.

“You have to get another piece of equipment, another wire, and do a measurement,” Tabaksblat says. “Sometimes it’s very difficult to figure out whether that measurement actually matches up with a certain lesion you see in the angiogram. So, a significant number of doctors find it hard to use, and therefore don’t use it all the time. I think the opportunity we now have at Philips, with Volcano being part of our company, is to totally change that experience so that it becomes as easy to use as something like a StentBoost. That’s what we’re working toward.”

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