This issue of CRM is dedicated to the top cardiovascular innovations presented at this year’s Cardiovascular Research Technologies (CRT) meeting. As we look back on what has attributed to the reduction in cardiovascular mortality and to what has improved the quality of life over the last decades, it is a combination of reduced risk factors and increased cardiovascular innovations, both in drugs and in devices. Over the last 30 years, we have experienced an explosion in devices that have changed the way we practice cardiovascular medicine.

Thrombolytic therapy first impacted the mortality rates of patients with myocardial infarction but stents used in primary percutaneous coronary intervention demonstrated an even further reduction in mortality and bleeding risk. Drug-eluting stents continued to improve stenting outcomes, with significantly reduced restenosis rates. Implantable defibrillators for patients with malignant arrhythmias were proven to save lives while cardiac resynchronization therapy improved the quality of life of heart failure patients. Left ventricular assist devices are available for patients with severe heart failure, and percutaneous trans-aortic valve replacement is employed for inoperable or high-risk patients with severe aortic stenosis. New antiplatelet and antithrombotic agents have been introduced to prevent thrombotic events, and new heart failure/antihypertensive/cholesterol agents have become standard of care to reduce cardiovascular mortality and to improve quality of life.

Cardiovascular innovation has become an integral topic at many large cardiology meetings, including CRT. Biodegradable scaffolds, renal denervation devices to treat resistant hypertension, and left atrial appendage closure devices to prevent stroke and bleeding in patients with atrial fibrillation were among the promising innovations presented at CRT 2013. The top 10 innovations, which address some of the unmet needs in cardiology, are detailed in the current issue. Two innovations address atrial appendage closure: the LAmbre™ device, a novel, self-expanding left atrial appendage occluder constructed from a nitinol mesh and polyester membranes, with full recapture and repositioning capabilities; and the Aegis Sentinel System, an innovation targeting thrombo-embolic stroke from atrial fibrillation, which features a hollow suture, closure of the suture via a percutaneous approach, and the use of electrical signal-based navigation.

For cardiac arrhythmia, in order to mitigate far field activation inherent to current pacing technology, inventors constructed a novel lead in which the cathode and anode are both intra-myocardial. Safety and efficacy are demonstrated for ventricular pacing at the atrio-ventricular septum in canines, opening a novel and potentially safer alternative to human cardiac resynchronization therapy. In addition, inventors presented a novel technique and device to navigate the oblique sinus and use DC current and saline/alcohol irrigation to selectively stimulate and block the autonomic ganglia found on the epicardial side of the heart.

Also presented is an intracoronary imaging device using attenuation-compensated optical coherence tomography, which allows better visualization of coronary artery diseases. A compensation algorithm, previously developed to correct for light attenuation in soft tissue and to enhance contrast in ophthalmic optical coherence tomography images, was applied to intracoronary plaque imaging using spectral-domain optical coherence tomography. Also highlighted is a Live Volumetric Imaging catheter capable of real-time, 3D, intra-cardiac echo imaging, which uniquely provides the combined desired features of full volume imaging with deep penetration depth and high frame rate.

Further, one particular system was designed to assess the efficacy of renal sympathetic nerve stimulation to increase systemic blood pressure; and a novel, balloon-based temporary aortic valve was designed as a hemodynamic support device capable of catheter-like insertion and retrieval based on acute aortic insufficiency severity. Also included is a novel approach for device placement at the aorto-left atria to create a conduit capable of accommodating a percutaneous left ventricular assist device. A novel mechanical thrombus aspiration system with new features to improve aspiration speed, control, and overall performance is presented; as is a dedicated radial ventriculography pigtail catheter that allows for faster and easier insertion in the left ventricle, which may reduce procedure time, radiation exposure and propensity for radial artery spasm.

All of the aforementioned innovations are quite interesting, and have the potential to improve cardiac quality of life and to perhaps further reduce cardiac mortality. Thank you to all of the inventors highlighted in this issue and we wish all of the innovators from CRT 2013 further success!