Coronary Chronic Total Occlusion
Yale Cardiology has among the worlds most prolific programs for recanalization of coronary chronic total occlusion (CTO). Yale cardiology performs > 200 coronary CTO PCI procedures annually and develops and applies a variety of innovative technologies and techniques to optimize success, safety, and clinical outcomes. These methods include advanced guidewires and crossing devices, retrograde techniques including controlled antegrade retrograde tracking methods (CART), reverse CART, antegrade and retrograde coronary reentry, intravascular ultrasound guided recanalization among others. Yale cardiology supports a variety of national and international meetings and educational programs to education physicians for methods and patient selection for CTO PCI and has frequent dedicated focused educational program for visiting physicians in practice. Yale serves as a worldwide quaternary referral center for this disease. The current success rates approach 95% without ever excluding a patient on the basis of complex coronary anatomy. Current efforts include development of new devices to improve procedural success, delineation of patient outcomes, and standardization of techniques and education for CTO PCI.
Peripheral Vascular Intervention
Yale Interventional Cardiology is among the country’s busiest programs in the treatment of non cardiac vascular diseases. This aligns with our model of global, “head to toe” care for the vascular patient. The interventional cardiology team at Yale treats a broad variety of vascular disorders with emphasis in primary and secondary prevention measures. The peripheral vascular team utilizes state-of-the-art technologies and is active in the development new supporting platforms for PAD including drug eluting balloons to reduce restenosis, new generation stent and atherectomy platforms for lower extremity disease, endovascular carotid stenting, and microvascular stenting for erectile dysfunction.
Transcatheter Aortic Valce Replacement
Aortic Valve Stenosis is a condition that can cause severe symptoms of collapse, angina, and heart failure and may quickly lead to fatality if not definitively treated with aortic valve replacement. However, many patients are at high or extreme risk for standard open heart surgical procedures due to frailty or other illnesses. New methods for full transcatheter aortic valve replacement (TAVR) are being utilized at Yale which do not require open chest and cardiopulmonary bypass. This is a multidisciplinary effort involving interventional cardiology, cardiac surgery, cardiovascular imaging, cardiovascular anesthesia, nursing, critical care and rehabilitation services. A single access line (Yale Valve Clinic) (855) 205-1755 or (203) 483-3115, or personal referral provides patient access to outpatient consultative services including same day cardiology, cardiovascular research, and surgical assessment as well as adjunctive imaging (CT chest - pelvis and echocardiography) as needed as part of an integrated screening process. This compact process can provide patients and referring providers rapid feedback and potential solutions for patients with high risk valvular disease.
Adult Congenital and Structural Heart Disease
The Interventional Cardiology Program at Yale is actively engaged in the management of patients with a variety of structural cardiac abnormalities including atrial septal defects, patent foramen ovale, ventricular septal defects, valvular stenosis, hypertrophic cardiomyopathy, and others.
Yale has a long tradition of being at the forefront of interventional innovation, being the first cath lab in the northeast to use rotational atherectomy and the first in New England to place an intracoronary stent. Yale cardiology currently leads and also participates in a variety of multicenter clinical trials including evaluation of novel drug eluting balloons, biodegradable coronary stent/scaffolds, dedicated bifurcation stents, novel therapies for coronary chronic total occlusion, percutaneous valve therapies, forward looking intravascular imaging, and modalities for cardiac biologic repair among others.
Yale interventional cardiology globally participates in the development of multicenter clinical device development trials in the United States, Europe, and Asia and can assist with protocol development, implementation, and regulatory approval via the Yale Cardiovascular Research Group (YCRG) and its associated core laboratories, led by Dr. Alexandra Lansky.
Yale - University College London Program
Yale cardiovascular medicine has affiliated with University College, London (UCL) to cultivate synergies between two of the world’s leading universities. Interventional cardiology programs between the Yale-UCL continue to develop strengthened relationships that include clinical cross credentialing between Yale and UCL faculty. Associated institutions in the United Kingdom are Heart Hospital/University College London Partners and the London Chest Hospital. This provides a unique platform for early access and experience with new cardiovascular devices prior to introduction to the United States, clinical faculty and fellow exchange, and integration of clinical research and device development programs in the United States and United Kingdom.
The goal of the Yale Interventional Cardiology Fellowship program is to train the next generation of clinical leaders and scientists in interventional cardiovascular medicine. The fellowship is comprised of 3 ACGME accredited positions for focused 1 year training in Interventional Cardiology. Additional opportunities exist outside this setting for adjunctive training in advanced cardiac structural intervention and peripheral vascular medicine/intervention. The core of interventional fellow training centers on the hands-on experience of performing cardiovascular interventions on a broad range of patients, with a wide spectrum of techniques and clinical scenarios. Yale Interventional Cardiology holds weekly meetings for case review, journal club, and a series of didactic lectures centered on core materials for the Interventional Cardiology Subspecialty Board Exam. Other educational venues include weekly Cardiac Catheterization Conference and Yale Cardiology Grand Rounds.
Interventional trainees participate in all university interventional procedures at Yale-New Haven Hospital and West Haven VA medical center, and have primary responsibility for inpatient evaluation and management of patients with acute MI, unstable angina and stable angina. Trainees are also encouraged to participate in the evaluation and management of patients with peripheral vascular disease, including participation of diagnostic and therapeutic procedures for iliac, femoral, renal, carotid, and subclavian disease. Outpatient training occurs through the Branford and Guilford offices of Yale Cardiology. All Interventional trainees see patients one half day a week for primary evaluation and for follow up after hospitalization or after elective interventions.
Interventional fellows may also actively pursue research interests in basic science, with recent trainees involved in angiogenesis, stem cell therapy, and cardiac gene therapy research. Fellow trainees are particularly encouraged to participate in these local protocols; nonclinical research time can be tailored to the individual trainees needs and toward completion of an independent research project. Collaborations with other members of the cardiology section and members of the medical school faculty are strongly encouraged. Opportunities exist for fellows to develop local clinical research projects as well as participate in national research agendas via innovative multicenter trials and/or through Yale Cardiovascular Research group and core laboratories.