Bichat Hospital belongs to the Assistance Publique Hôpitaux de Paris (APHP), a large network of 30+ public hospitals in the Paris area, and is the lead interventional cardiology centre of APHP in the northern part of Paris. The cardiac intervention team comprises ten physicians and eight nurses, who perform 2,500 annual coronary procedures, including 900 percutaneous coronary interventions (PCI), 25% of which in an emergency setting.

A service of this magnitude requires a 24/7 access to the cathlab and on call hospital staff. Due to strenuous financial constraints, our staff is relatively small.

Most of the PCI – even emergent PCI – are performed by a single operator; also, we share our nurses with the structural intervention team, a situation that often leads to only one coronary cathlab running for half days.

Personnel involvement has been key to face these constraints. “I am blessed with a team of wonderful people who work in concert for the community. The functioning of our cathlabs during the recent COVID-19 epidemics is a testimony of that. Altogether, it is a pleasure to work here,” he said.

Another great help to meet the increasing demand in cardiology interventions is high quality equipment and Prof. Feldman’s team has recently purchased two Alphenix Core + rooms.

The cardiology team also wanted to better integrate the cathlab in the hospital information system and connect the equipment more fluidly to the reporting system and PACS.

“We were longing for a major strategic breakthrough that would facilitate our long hours spent in the cathlab, improve safety for caregivers and patients, and altogether be more gratifying for the team and the institution,” he added.

The Alphenix Core + has brought all these advances and enables to quickly and safely perform all kinds of diagnostic and interventional coronary procedures, from basic coronary angiography to the most complex programmed or emergent PCI. Even cardiac surgeons perform cardiac biopsies with Canon’s system every day.

Bichat Hospital is a leading centre for heart and lung transplantation, performing a lot of right heart catheterisations and cardiac biopsies. To relieve the strain put by the shortage of anaesthesiologists, the team has also started to perform structural interventions that do not require general anaesthesia, e.g. patent foramen oval closure under intracardiac echocardiography guidance or percutaneous mitral valve balloon commissurotomy in the Alphenix Core + rooms.

Prof. Feldman started working in the first Alphenix Core + room in November last year. The second room opened in March 2020, as the COVID-19 epidemics broke out in France, affecting particularly the northern east part of the country and Paris.

At Bichat Hospital, non-emergent coronary procedures were almost completely stopped as a result. “We have been very lucky that both Alphenix Core + rooms were almost completely installed in due time before the outbreak. As we emerge only now from this standstill, I think we still haven’t had enough time to enjoy all the potentials of the Alphenix Core + technology. It is still a work in progress,” Prof. Feldman said.

Live Zoom has also been broadly adopted by the team, who by default starts every procedure with a 30 cm field of view and a 1.8 Live Zoom magnification, i.e. the equivalent to a 17 cm field of view but with much less irradiation. The multiple layouts of the monitors have also generated a lot of enthusiasm from users.

Dose reduction was a major benefit sought by Prof. Feldman and his team. Coronary interventions have become extremely successful and safe at tackling very complex lesions, but these kinds of complex PCI are time consuming and radiation dose becomes an issue, and even an obsession. “Dose reduction is now a top priority everywhere in the guidelines, but how to achieve it is not always at hand. All the tools that have been made available to us with Alphenix Core + have been very useful to improve the overall safety of our procedures radiation-wise - Spot ROI and Live Zoom, but also sound alerts and the very intuitive dose tracking system,” he reported.

With the Alphenix Core +, the team can now lower dose by 40 to 50%, in addition to the intrinsic built-in dose reduction algorithms of the system per se. “It is a huge and constant source of satisfaction,” he said.

A key motive for purchasing the new equipment, and one to which Bichat paid much attention, is the system’s excellent integration with the hospital’s reporting system (Cardioreport, Medireport), information system and PACS (Orbis, Agfa), as well as the multimodal imaging systems that have become a must in sophisticated interventions, for example intravascular ultrasound, optical coherence tomography, fractional flow reserve, and intra- or extracardiac ultrasound.

“This successful integration of the cathlab in its digital environment has been a great source of satisfaction for all of us since we had been advocating this move for a long time and no one at APHP had succeeded in implementing it to such an extent. Kudos to the engineers and technicians of our institution, our imaging partners and the Canon team!” he said.

Having a state-of-the-art cathlab facility is also a strategic investment for Bichat in the current clinical landscape, as many private interventional cardiology centres have emerged over the years and become direct competitors. “In this competition, there is no room for obsolete equipment and out-dated technology. Our administration was fully aware of our lagging behind in terms of cathlab facilities and was eager to improve our working conditions to stay competitive and maintain a high level of activity. Cardiac interventions is a strategic asset for the hospital and represents more than 50% of its financial incomes,” he said.

With the Alphenix Core +, Bichat Hospital will rank among the top institutions in Europe, being able to perform high volumes of cases, focus on complex PCI, such as bifurcations, chronic total occlusions or high risk acute coronary syndromes. “Being a European leader means all that and also teaching interventional fellows coming from abroad, leading and participating in high level multicentre research, and organising teaching courses and live cases. All these services require first class cathlab equipment and technology,” he said.

“Working in only one room can be challenging in cardiology since emergencies can come up any time. Therefore, we organised some back-ups with a vascular room in the radiology department and with our hybrid room in case of an emergency or very busy schedule. Most importantly, thanks to everyone’s motivation, we suffered no delay in the installation of the new rooms and the process took seven to eight weeks each,” Prof. Feldman said.

Another challenge was for everyone involved in the project to speak the same language. The cardiology staff had to understand Canon technology specifics and foresee how it fits in practice, while the hospital information system had to accept a relative loss of sovereignty when opening the access to external actors.

The Canon team put together the pieces of the project and played the role of a relentless coordinator, always eager to offer the best of its technology no matter the obstacles, Prof. Feldman recalls.

“For sure, this atmosphere of “shared positive thinking” was instrumental in the overall success of the enterprise. Such a complex project would not have succeeded without a close partnership between Canon and Bichat. Such a partnership entails many aspects, but most importantly it must be two-way, with Canon putting its best technology (and the way to use it) on the table, and the hospital offering access to its expertise and needs in cardiac interventions. No doubt that this partnership will be long-lasting in the interest of Canon Medical, the cardiology team, and, above all, the patients,” he concluded. //