AMIRALI BANANI
EXPERIENCIAS
Internship at Centre for Cardiovascular Innovation — Centre d’Innovation Cardiovasculaire (CCI-CIC)
VANCOUVER GENERAL HOSPITAL , VANCOUVER, BC, CANADA | MARCH 21-24, 2023
During spring break in 2023, I had the splendid opportunity to intern for a short period at the Centre for Cardiovascular Innovation, a clinical research centre operated by the University of British Columbia (UBC) Faculty of Medicine that facilitates regional and international clinical trials for cardiovascular researchers in BC investigating novel therapies for the treatment of certain cardiac conditions. This internship took place at Diamond Health Care Centre and Jim Pattison Pavilion at Vancouver General Hospital in Vancouver, Canada under the guidance of Dr. Brady Robinson. Below are some of the incredible activities that I did at CCI-CIC as well as my reflections on the experience.
ACTIVITIES
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Overview of CCI and the innovative projects that CCI researchers are working on to revolutionize cardiac procedures. This was led by Dr. Brady Robinson, Clinical Research Project Manager at CCI-CIC, whose current research project — called COMPLETE TAVR (CTAVR) — focuses on essentially combining Transcatheter Aortic Valve Replacement (TAVR) and Percutaneous Coronary Intervention (PCI) into a single procedure that can help patients with symptomatic aortic stenosis (AS) get treated while managing their concomitant coronary artery disease (CAD). Currently, patients who have CAD and have had PCI done in the past can not receive a TAVR to treat their AS, but CTAVR is set to make it possible to do so. The study is a stratified randomized trial led by the UBC Faculty of Medicine / Vancouver General Hospital with participating medical research institutions across Canada and the United States. 4,000 patients and 100 participating institutions are required for the study (∼200 patients and 60 institutions have been incorporated as of March 2023), and once complete, CTAVR would be the largest study of its kind in the world. Its results will be published in the prestigious New England Journal of Medicine and could have tremendous implications if successful.
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Observing cardiac catheterization procedures in the Cardiac Catheterization Laboratory (Cath Lab) at Vancouver General Hospital. In these procedures, catheters were inserted through the patients’ common femoral artery and pushed up to the heart to assess blood flow in the coronary arteries with angiography (using X-Rays and contrast dye injected by the catheter). The catheters were also used for PCI: a coronary revascularization procedure performed by the insertion of stents that open up blocked coronary arteries in patients with CAD.
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Assessing the suitability of several patients to participate in the CTAVR research study using inclusion and exclusion criteria assessing the patients’ current cardiac health (based on measures such as heart rhythm, blood pressure, jet velocity, LVEF, AVA area and index, lesions in coronary arteries, and NYHA Functional Classification during physical activity) and medical history (which entails past cardiac or other related medical conditions and operations).
REFLECTIONS
For me, the most influential part of my work experience at the UBC Centre for Cardiovascular Innovation was acquiring first-hand insight into COMPLETE TAVR, the flagship research project that the team of CCI researchers is working on. Once again, this developing research study is aiming to develop a method to treat a condition known as aortic stenosis in patients with coronary artery disease using cardiac catheterization, which dismisses the need for surgical procedures. As part of this experience, I got to observe the day-to-day tasks of Dr. Brady Robinson (as a reminder, the Clinical Research Project Manager of CTAVR), who regularly hosted meetings with scientists from different health institutions across Canada and the United States who are participating in the study and sought to recruit new patients for the study based on a set of inclusion/exclusion criteria to determine whether they are suitable to participate in CTAVR. As previously explained, as part of one of my favourite activities, I played the role of a research coordinator as I got to review these criteria and decide whether a set of four patients with different cardiac conditions and medical histories were eligible for the study. And of course, I had the opportunity to observe live cardiac catheterization procedures in the Cath Lab at Vancouver General Hospital, which was a tremendous experience!
During my time at CCI, I learned a lot about how new research studies are formulated and developed through an extensive process of research design development, patient and researcher recruitment, and innovation — one that may take several years to prepare and perform. I also learned how and for what purposes cardiac catheterizations are performed to diagnose and treat cardiovascular conditions like coronary artery disease, as well as how modifications to this cardiac procedure can open up a whole new scope of opportunities to treat cardiovascular diseases without the need for risky surgical operations. After completing this work experience, I have developed an even greater understanding and passion for medical research.
The biggest challenge I had during my placement was probably in the Cath Lab at VGH as I tried to understand step by step what was going on during the cardiac catheterization procedures through the monitors in the control room that displayed the angiographic images and ECG recordings. The angiographic images were black and white and — before the dye was injected by the catheter to highlight the coronary arteries — showed the heart, its arteries and the surrounding parts as faded objects, which sometimes made it difficult to identify where the catheter was during the process and thus what exactly was happening at each stage of the catheterization. The way I overcame this challenge was by simply asking the specialists in the control room to explain to me exactly what I was looking at on the angiogram as well as what was going on at each step, whether it was the insertion of the catheter through the aortic arch and into the heart or the injection of iodine dye into the coronary arteries (a more visually prominent step). Always satisfy your curiosity by asking questions, which in turn will satisfy your thirst for knowledge!
CONCLUSION & APPRECIATION
My goals for this placement were to deeply explore some of the innovative research taking place at CCI and acquire experiential exposure to the process of research in medicine, which I would love to pursue in the future. I have certainly achieved these goals as I am now much more aware of the large-scale preparation that goes into making studies like COMPLETE TAVR possible.
I sincerely thank Dr. Brady Robinson for spending time off his busy schedule to show me around and teach me about CCI as well as the COMPLETE TAVR project and Dr. Jacqueline Saw for demonstrating first-hand how cardiac catheterizations work in the Cath Lab at VGH. This work experience certainly wouldn’t be so rewarding without them.
I laud the efforts being made by researchers at CCI-CIC to innovate in the field of Clinical Cardiology and wish them the greatest success in the future.
CCI-CIC website: https://cci-cic.org