SASCI Boston Scientific RC Fraser International Fellowship in Cardiovascular Intervention Program
My first contact with the department was through the secretary to Prof Redwood, Della Spencer, and I would like to express my gratitude to her for the help and support. She helped me to get hold of the right departments to arrange the occupational health screening as well as the accommodation department. She was also my direct contact to Professor Redwood. The Occupational health department and especially the accommodation department was very helpful and efficient.
All the staff, both clinical and administrative was very efficient and friendly and they made me feel at ease in a very different environment.
I have been exposed to procedures that I have not seen in great numbers before such as TAVI and left atrial appendage closure devices. The efficiency of the TAVI teams was exceptional and it was such an experience to see Prof Redwood operate. He makes this procedure seem so simple and it was a privilege to see him at work. I was exposed to the Boston Lotus, Medtronic Evolute and the Edwards valves. Also not only trans femoral approaches but also trans apical and trans aortic approaches. I found the collaboration between the cardiologists and the cardio thoracic surgeons very different to my South African experience.
I have also seen many aortic valve balloon valvuloplasty, which is not something we do in South Africa that often. I have further been exposed to rotational artherectomy, CTO proceduresand research related techniques such as Doppler coronary wires, , invasive pressure-volume determinations and bicycle-ergometer stress haemodynamic studies.
There is general agreement in the approaches and techniques used, such as radial access being preferred, but also notable differences such as the second operator in most cases being another doctor. I think that the registrars in interventional cardiology benefit greatly by having somebody teaching them hands on and in every case as a second operator. I found the use of monoplane interesting since most new labs in South Africa are now bi-plane. I have been using only nitrate for vasodilatation in the radial access, mainly due to the unavailability of Verapamil, and I found it reassuring that St Thomas’ use this as the preferential approach and they only add Verapamil in cases with severe spasm. I do not think we give enough attention to activated clotting time during procedures and I am paying much more attention to it now.
I have learned a great deal in the 4 weeks, especially in the smaller detail, where Prof Redwood explained the rationale behind all the decisions very well and I believe that I will be a better interventionalist because of my visit.