DMC interventional cardiology expert shares new national guidelines on novel, catheter-based way to access heart

AUSTIN, Texas – An expert Detroit Medical Center cardiologist who specializes in coronary intervention and catheter-based heart procedures presented a new set of guidelines for a novel way to access the heart.

DMC Heart Hospital’s Dr. M. Chadi Alraies, director of DMC’s Cardiac Catheterization Lab, led the talk July 22, 2023 at CVI 2023, a conference of the Cardiovascular Innovations (CVI) Foundation. The gathering in Austin, Texas, included about 1,200 interventional cardiologists, interventional radiologists, vascular surgeons, nurses and heart catheterization lab technicians.

Dr. Alraies shared the guideline’s specific steps to reach the heart through a vessel in the arm, called axillary artery access, for patient procedures that need larger catheters to move devices like heart valves and heart pumps. Traditional access to the heart for larger catheters is through a vessel in the groin area, called femoral access.<> Once the catheter reaches the heart, the interventional cardiologist can then repair or replace heart valves, insert devices to treat different structural heart issues or insert a tiny, straw-sized heart pump to support blood flow in the heart for patients in cardiogenic shock.

“This newer technique was developed a few years ago, but leaders in cardiology from across the United States created these guidelines for hospitals still learning how to access the heart through vessels in the arm,” Dr. Alraies said. While we are very experienced in radial access at DMC, the comfort and experience at many health systems varies. So these guidelines are important, ultimately to help save and improve lives for patients not only in Metro Detroit but across the United States.”

Dr. Alraies helped develop and publish guidelines for the procedure in 2022 for the Society for Cardiovascular Angiographer & Interventions (SCAI) with cardiology experts from the Cleveland Clinic, Emory University School of Medicine and other health systems across the United States. He was the only cardiologist in Michigan to contribute to the guidelines.

“People who need TAVR (transcatheter aortic valve replacement) or need to have a supportive heart pump placed, these patients usually require a large vessel, typically a vessel in the leg,” Dr. Alraies said. “But if these vessels are narrowed by plaque buildup or access is difficult because the vessel curves and twists around quite a bit, in the past, that could eliminate the catheter-based treatment option. This was terrible news for those who need these procedures. Using an axillary artery through the upper arm provides new opportunity for those patients.”

SCAI is the only professional medical society in the United States dedicated solely to advancing the field of interventional cardiology, or using catheters to access and repair conditions of the heart. The new SCAI guidelines lay out steps on evaluating patients, best practices to effectively and safely access the heart and how inexperienced health systems can best train their teams to do so. The guidelines lay out a proctorship process, where an experienced interventional cardiologist trains others to achieve successful access to the heart through the arm.

For more information on DMC Heart Hospital’s expertise in TAVR, PCI or other interventional heart procedures, visit www.DMC.org/heart.