Proceedings of TRICO 2020 from desk of Tejas Patel


TRICO 2020, the Fifteenth International Transcatheter Intervention Course was held on 8th and 9th of February, this year. This year the scope of TRICO was widened by changing its name from “Transradial Intervention Course” to “Transcatheter Intervention Course”.

Transradial interventions are already in the mainstream and practically every interventional cardiologist is aware of them and most have already started putting them into practice. This year’s Transcatheter Intervention Course included Coronary and Peripheral interventions, Imaging, Physiology and Robotics and in the future we plan for TRICO to also include structural interventions.

We were delighted that Dr. Shigeru Saito of Japan was able to join both Sanjay and myself as the Course Director. Samir Pancholy of the U.S.A. also agreed to be a Course Director.

TRICO 2020 was and intense course packed with 11 hours of live demonstrations and 10 didactics delivered by our international guest faculty; Takashi Akasaka from Japan (the world authority on OCT imaging), Malcolm Bell and Rajiv Gulati (Mayo Clinic, Rochester, U.S.A.), Mauricio Cohen (University of Miami, Miami, U.S.A., Luis Guzman (Wake Forest University Hospital, N.C., U.S.A.), Tak Kwan (Mount Sinai Beth Israel Hospital, N.Y., U.S.A.), Aaron Grantham (St. Luke’s Mid America Heart Institute, Kansas City, U.S.A.), Kintur Sanghvi (Deborah Heart And Lung Centre, N.J., U.S.A.), Fazila Malik and Md. Khaled Mohsin (N.H.F. Hospital, Dhaka, Bangladesh), Mir Jamaluddin and Sabina Hashem (N.I.C.V.D., Dhaka, Bangladesh).

We were also lucky to have 24 patients that agreed to undergo interventions as part of our live demonstrations. They had all been admitted to Apex Heart Institute and I able to ensure that the operations could be successfully broadcast from Apex to Nirma University Auditorium. On the evening of 7th February, I invited all the International Guests for a very enjoyable dinner at my home, with the unfortunate exception of Dr. Akasaka and Dr. Saito who were arriving just before midnight, and John Coppola (N.Y., U.S.A.) who had to cancel TRICO this year because of personal reasons, as well as our friend Tejan.

On the morning of TRICO, on behalf of The Apex Heart Institute, I welcomed 419 participants from many different countries, including 78 interventional cardiologists from Bangladesh; very sincere and disciplined participants.

The first case was a complex left main bifurcation stenosis, which was performed smoothly by Sanjay and I with Dr. Akasaka and Dr. Gulati ason-site moderators. During the procedure we were also able to engage in intense discussion between the panel sitting at Nirma Auditorium and the on-site moderators. We were also able to demonstrate the use of bifurcation software in OCT and Dr. Akasaka taught everybody how to interpret it. The end result was excellent.

The second live case was a difficult RCA CTO during which Dr. Saito, with Rajni, were able to give an excellent live demonstration. He elegantly crossed the CTO in his typical Japanese style and stented it, and then confirmed the result using high definition IVUS imaging.

The third case was a Robotic PCI of mid-RCA stenosis done by Sanjay and myself. Sanjay, along with Yash showed the preparation of the cassette and I set on the console and did the case. There was a lot of discussion about the present status and the future of r-PCI. Everybody enjoyed the case which ended the first live demonstration session.

The beginning of second session was by a talk “Interventionalist’s Health in the Cath Lab” by Dr. Malcolm Bell. It was an excellent talk on such a sensitive issue and was extremely well received by the audience. The fourth live case was a complex RCA bifurcation stenosis done by Dr. Tak Kwan with Rajni. He very elegantly demonstrated the case and confirmed the result using OCT guidance. Dr. Luis Guzman was on-site moderator and he led excellent discussion with the panel and the operator. The fifth case was Rota-Stenting of heavily calcified LAD and LCX lesions done by Sanjay and I. We did several runs of OCT imaging and generated some great discussion with the panel.

After the lunch break, we had two talks back-to-back from Dr. Vijaykumar on “Interpreting IVUS imaging in daily practice” and then from me on “How I incorporated OCT imaging in my practice”. Both the talks were well received. The third live demonstration session started with a complex LAD Endoluminal reconstruction case done by Dr. Saito with Rajni. It was eventually converted into an LMCA bifurcation PCI. Dr. Saito did it beautifully using high definition IVUS imaging very elegantly. On-site moderators Dr. Malcolm Bell and Dr. Aaron Grantham were able to lead some great discussions with the panel and Dr. Saito. The second case was a calcified mid-LAD lesion which was done by Dr. Aaron Grantham with Sanjay using the Robot. Aaron did it very nicely, also demonstrating OCT imaging using the robot. The third case was a critical right ICA stenosis done by Sanjay and I. We used the distal protection device and stented the lesion in a short span of 20 minutes. The fourth live demonstration case was a very quick Robotic PCI of critical LAD lesion also done by Sanjay and I. Both of us felt that the level of interest in the audience on the r-PCI was even greater than TRICO-2019.

That evening we assembled for the Gala Dinner at the venue where everyone was able to enjoy the delicious Indian food in a wonderful environment.

On the morning of 9th February at 9 a.m. we started with the fourth live demo session. The first case was a complex LAD diagonal bifurcation stenosis done very elegantly by Dr. Mauricio Cohen with Rajni; OCT imaging with Dr. Akasaka interpreting the result. The second case was done by Dr. Samir Pancholy with Sanjay; a multi-vessel complex PCI. Samir used high definition IVUS imaging and did the case very elegantly with Mauricio and Fazila as on-site moderators discussing the case very well with the panel. The third live demonstration case was a complex LAD CTO done by Dr. Saito with Rajni. The high definition IVUS imaging was done beautifully and the discussion on IVUS interpretation between Dr. Saito and Dr. Akasaka was a real treat for everybody and taught us a great deal.

The fourth live case was a complex LAD Endoluminal reconstruction, LMCA bifurcation and a critical LCX stenosis performed by Sanjay. and myself where Kintur demonstrated the use of “Railway” sheathless insertion very nicely. It was an extremely tough case which Sanjay and I did very systematically. The OCT imaging and use of bifurcation software, along with it’s interpretation done by Dr. Akasaka, was an intense period of learning for the audience.

After lunchthat day, there were seven consecutive didactics delivered by the world authorities. Everybody enjoyed the talks. In true sense it was an academic feast. There were also a few complex PCI angiograms presented by faculty as well as participants. They were great cases and they generated good discussions. At 6 p.m., we ended the course with my concluding remarks.In true sense it was a grand success and everybody learned a lot and enjoyed the course a lot. Next year we are planning to show structural interventions including TAVR and LA Appendage occluder implantation.

I express my sincere thanks and gratitude to Dr. Saito, all the international guest faculties, as well as national guest faculties for helping me to create one more success story. I am looking forward to welcoming you all to TRICO 2021, to be held on 13th and 14th February, 2021.

Tejas Patel,
Course Director,
TRICO 2020.