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From Fellowship to Frontline: How Advanced Training Translates into Real-World Impact in Structural Heart Interventions

At ADN CoE, our mission has always been clear: to empower physicians with the advanced knowledge, technical expertise, and clinical confidence required to perform complex cardiovascular procedures independently and safely. The true measure of any fellowship program is not the certificate awarded at the end it is the moment when a fellow returns to their institution and successfully applies those skills to improve patient outcomes.

Today, we are proud to share such a moment.

One of our fellows has successfully performed a highly complex structural heart intervention, a Valve-in-Valve Transcatheter Aortic Valve Replacement (TAVR) combined with the BASILICA technique, achieving excellent procedural and clinical outcomes. This case represents not only a technical success but also a significant milestone in advancing structural heart therapy within his region.



Patient Background and Clinical Challenge

The patient was a 73-year-old female presenting with progressive heart failure symptoms over a six-month period. Her clinical evaluation revealed severe aortic stenosis resulting from degeneration of a previously implanted 19-mm Trifecta surgical bioprosthetic valve, which had been placed in 2018.

Her clinical condition was further complicated by:

  • Impaired left ventricular function, with a Left Ventricular Ejection Fraction (LVEF) of 35%

  • Moderate pulmonary arterial hypertension (PAH)

  • Progressive symptomatic deterioration affecting quality of life

Given her age, cardiac function, and surgical history, she represented a high-risk candidate for redo open surgical aortic valve replacement.

A multidisciplinary heart team evaluated her case and considered two options:

  • Redo surgical AVR with root enlargement

  • Valve-in-Valve TAVR as a less invasive alternative

Based on clinical risk, imaging findings, and procedural feasibility, the team opted for Valve-in-Valve TAVR. However, detailed CT imaging revealed an additional critical concern.


Advanced Imaging and Procedural Planning

Pre-procedural CT analysis demonstrated anatomical features that placed the patient at significant risk for coronary artery obstruction during the Valve-in-Valve procedure a known and potentially catastrophic complication.

Precise measurements included:

  • Critically short valve-to-coronary distances

  • Leaflet positioning that posed a high obstruction risk

  • Anatomical alignment requiring careful procedural modification

These findings indicated the need for a BASILICA procedure (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Coronary Artery Obstruction).

This highly specialized technique involves intentional leaflet laceration to prevent coronary occlusion during valve deployment and requires advanced procedural skill, precise imaging interpretation, and extensive training.


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Clinical Outcome and Post-Procedural Success

The patient’s post-procedural course was highly favorable.

Echocardiographic follow-up revealed:

  • Single-digit mean gradient across the new valve

  • No paravalvular leak

  • Improved valve hemodynamics

  • Stable cardiac function


The entire procedure was completed successfully using a minimally invasive percutaneous approach.

The patient recovered well and was discharged on post-operative day three, highlighting the clinical benefits of transcatheter structural heart interventions when performed with precision and expertise.


Translating Fellowship Training into Clinical Excellence

This achievement is particularly meaningful because it reflects the direct application of advanced skills developed during fellowship training.

The successful execution of this complex BASILICA-assisted Valve-in-Valve TAVR required:

  • Advanced understanding of structural heart anatomy

  • Expertise in imaging interpretation and procedural planning

  • Technical proficiency in catheter-based interventions

  • Confidence to perform high-risk structural procedures

  • Ability to manage procedural complexity and complications


These are precisely the competencies that ADN CoE fellowship programs are designed to develop.

Our training approach emphasizes:

  • Hands-on procedural exposure

  • Real-case clinical learning

  • Expert mentorship from internationally recognized faculty

  • Structured progression from observation to active participation

  • Comprehensive understanding of advanced interventional techniques


A Milestone Beyond One Procedure

This case represents more than a successful intervention. It represents the fulfillment of a broader mission building physicians who can safely and confidently perform advanced procedures and contribute to improving patient care globally.

It demonstrates how structured, hands-on fellowship training can directly impact real patients, hospitals, and healthcare systems.

For ADN CoE, this moment is a source of immense pride.

Seeing our fellows evolve into independent operators capable of performing complex structural heart interventions validates the purpose of our programs and reinforces our commitment to advancing global medical education.


The ADN CoE Commitment

At ADN CoE, we remain dedicated to:

  • Advancing procedural excellence in cardiovascular medicine

  • Supporting physicians in their journey from trainee to independent specialist

  • Expanding access to high-quality fellowship training worldwide

  • Contributing to the global advancement of structural heart interventions


Our fellows’ success stories are the strongest testament to the value of hands-on medical education.

Because the true impact of fellowship training is measured not in classrooms, but in cath labs, operating rooms, and the lives saved through expertise.





 
 
 
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