20 May 2025
EuroPCR 2025: Cutting through the complexity
Complexity is the fil rouge of this year’s course but what does it mean to the Course Directors? And how can EuroPCR help participants cut through the complexity?
Complexity has three different levels for many of us: procedures are becoming increasingly technical, our patients are becoming more complex to manage due to their age and co-morbidities, and our working environments are often under strain with limited resources. We have designed a ‘Complexity track’ in the programme that illustrates these points, providing solutions to the complex problems that are now part of our daily practice.
Relating to healthcare delivery, the Complexity track includes a session that provides updates on the RESIL- Card project, which aims to build resilience in cardiovascular care in times of crisis. In addition, a session in collaboration with Stent – Save a Life! discusses managing complex STEMI patients in diverse healthcare systems, with perspectives from Africa, Latin America and Asia.
Complications are a level of complexity that no one wants to encounter. One of the highlights of this year’s programme is our ‘Best Companions’ case sessions. We have received some amazing submissions, including very tricky cases on complications, which we can all learn from to reduce the likelihood of events taking a turn for the worse.
Sharing is an essential part of the PCR DNA – by sharing our experiences, we can reduce the learning curves for each other.
Complexity is something that we face every day as the lesions in the patients we treat are becoming more complicated – and the increasing prevalence of coronary calcification exemplifies this. Up to a quarter of patients presenting for planned PCI now have angiographically detectable calcium, which may be due to factors such as advanced age and co-morbidities, including diabetes and kidney disease.
Performing PCI in patients with calcified lesions is now unavoidable for interventional cardiologists. An understanding of the underlying pathophysiology is important, and, given the potential for adverse outcomes, we need to equip ourselves with the right skill set to deal with these complex lesions. Modifying calcium prior to stenting can optimise stent expansion, and intracoronary imaging can facilitate not only the detection of calcium but also the confirmation of adequate modification and stent optimisation.
Knowledge is power and sharing best practices at PCR Courses and Webinars is helping us to treat complex lesions with more confidence.
I recommend sessions held in collaboration with the Euro4C Group if you want to learn more about how to tackle difficult cases head on.
Our small interventional cardiology world is no different from the wider one – the complexity of our working environment is increasing. We find ourselves dealing with more patients but with less time and fewer resources. Efficient streamlined teamwork within our cathlab teams is essential, especially when performing difficult procedures. And our wider teams have grown much more complex as more specialties have developed. As we manage patients with multiple comorbidities – with involvement from diabetes specialists, nephrologists, emergency specialists, etc. – it is more important than ever that proper patient pathways are in place so that the right patient is seen by the right doctors, not just by one doctor. Healthcare organisation and delivery needs to evolve as the patient population changes.
Several initiatives are visible during the course that will help to highlight that interdisciplinary teams lead to more personalised patient care and better outcomes.
Sessions from the PCR Tricuspid Group and from two new groups – the PCR Mitral Focus Group and iHF (Improving Heart Function) initiative – are designed to show that complex cases can be better managed when specialties work together.
In some ways, our success has created even more complexity. As an example, the frequency of TAVI has risen greatly as indications have expanded, and we now face the prospect of patients outliving their new valves – something that we would not have thought possible a decade or two ago.
But this example highlights how we rise to challenges as a community to find solutions.
We are learning from trials and registries how to optimise patient and valve selection to improve durability. In addition, new procedures are being developed, including standalone TAVI-in-TAVI, complex TAVI-in-TAVI and also surgical explantation with re-implantation. Research is also ongoing into areas relating to improved durability, including valve leaflet fabrication, new valve designs and sizes, and post-implantation pharmacotherapy. And so, typical of our field, we overcome hurdles with insights and innovations.
Find out more from Hotlines, abstracts and clinical cases, and from sessions held in collaboration with national societies as our global experience in this and other complex areas evolves.
The best interventionalists are brilliant at making complex things look simple.
The skill of a great operator is the ability to simplify a procedure, whilst simultaneously understanding every step, anticipating every eventuality, and remaining prepared to deal instantly with whatever may happen.
This is something that we are aiming to achieve through the course at large – making difficult things easier for our colleagues, not only through live demonstrations, but also by hands-on experience. The Hands On Lab, Imaging Skills Labs, Simulation Learning Room and Training Village are all there to take you through procedures step-by-step. And many of the best interventionalists are there to help you make the most of these opportunities.
One of the highlights this year is an in vitro demonstration of DK crush stenting. A LIVE Educational Case takes the complex anatomy out of the patient and puts it into a simulator model, thereby removing the patient from the risk and allowing us to learn how to do complex procedures in a non-clinical environment.
Whether it’s a simple procedure or a complex lesion in a complex case, we must start with the patient at the centre and provide them with the best possible treatment.
Often, the best treatment is the simplest. If a new procedure can only be performed by a few experts in the world then it may not be the right procedure. Innovation has brought us a long way in interventional cardiology but we only need to use it if the evidence indicates that it adds value. We have to evaluate the data and be honest with ourselves and the community, otherwise we are introducing unnecessary complexity. Does this new device address an unmet need? Will it change my practice? Or is it out of reach due to expense or extreme difficulty? If it is useful, how can I help make it available more widely?
This is why there is so much focus on discussion at EuroPCR. We want participants to ask questions if they want to know why a step was performed in a certain way or if they have suggestions for an alternative approach. Many of this year’s LIVE Educational Cases were chosen to represent complex cases – not because the operators want to demonstrate their technical prowess, but because these are cases that we may encounter in our daily practice and where education can make a huge difference to outcomes.
