Good evening, my name is Arnold Cito and it's my pleasure to introduce on behalf of the committee, led by Cindy grinds also Linden box mamas mamas jaydon Abbott, James like a ship, James, James Jeff car, Nick Curzon, William Kent, yes and Katie, Alexis Mattel, Jennifer Reimer, Ted Schreiber, who don't find like a booty for London Vidovich and Steve Waldo, the sky expert consensus update on PCI without on site surgical backup. This document is available now online at J sky when and is and has been widely disseminated through email. So we're going to talk tonight, I'm going to give a five minute introduction, then Dr. Cindy grinds our sky past present will give 10 minutes on the evolution of PCI practice environment, how surgical backup went from absolutely essential to rarely necessary. jaydon Abbott will then give us the evidence supporting PCI at non cardiac surgery centers. And then we'll be lead off into some roundtables, led by a deer Shroff on how to optimize your cath lab rescue capabilities to make high risk PCI and patients safe without surgery on site. And then Linden box will give us an update on ASEs and OBLs and how you have case selection and manage your financial pressures for PCI in the outside out of hospital settings. We will have 15 to 20 minutes for discussion and audience questions. And we have an excellent set of panelists. Jeff car from cardio stream Tyler endovascular center so hot ball, chief cardiology at Mass General Brigham Salem Hospital, London Vidovich chief cardiology at the Chicago VA and Ted Schreiber at Trevor cardiology. So I just wanted to go over quickly the key points of this document which will be reviewed as well throughout the discussion but essentially elective PCI in surgery in settings without onsite surgery have increased in volume and complexity, extending well beyond the simple lesion recommendations in the older 2014 document, and it's now being performed in non hospital settings such as OBLs and ASEs. Many new studies in the US and abroad have demonstrated that this is safe with low rates of complications and similar outcomes. And despite increases in age, comorbidities and lesion complexities, the rate of emergency surgery is as low as .1% in major in many series. This includes multiple complex PCI including left main. So we propose a new PCI treatment algorithm that expands the types of cases that can be formed can be performed at places without cardiac surgery compared with the 2014 document. And this may lead to considerable financial savings in different health care systems. One of the key slides on the document are how to manage the case selection. And we have this and it divides the settings into the cardiac surgery facilities, the level two non SOS hospital, the level one non SOS hospital, and then the ASE and OBL with concomitant cases to potentially avoid in these settings. These are in the figures. And the algorithm for this is that essentially if those patients need any of the services in the hospital such as transfusion, have a high AKI risk or respiratory failure risk, then they should be done in the hospital as opposed to the ASE. In those patients who have a decreased EF or planned atherectomy, then they should be performed in hospitals with those capabilities to rescue patients from cardiogenic shock or to perform atherectomy. And then only in those patients who absolutely are surgical candidates and may be having a very high risk PCI, retrograde epicardial CTO or sole remaining vessel PCI. That's where PCI without cardiac surgery on site is absolutely mandatory. And any PCI can be performed at a higher level of care than absolutely necessary. But this algorithm at least tells you the exclusions. This is in major contrast with the 2014 document, which had as its critical recommendation that high risk patients with high risk lesions should not undergo non-emergency PCI at a facility without on-site surgery and that high risk patients with non-high risk lesions could perform it, but only when surgery was immediately available. This document also required that surgeons have privileges at these non-cardiac surgery hospitals, which were rather limiting. So with that, I will hand off to Dr. Cindy Grimes, who will tell us how did we get here and the history of these documents.

PCI without on-site surgical backup

evolution of PCI practice environment

financial pressures for PCI

PCI treatment algorithm

Dr. Cindy Grimes