Advances in cath lab include the need to lower radiation dose, boost image enhancement, and enable fusion imaging.

The demand for catheterization laboratories is set to rise with several new healthcare centers being set up across the country. Hospitals are currently in a challenging predicament of changing regulations and intense scrutiny of proper reimbursement, along with pressure to reduce costs and achieve high-quality outcomes, which is transforming the way care is provided across all clinical service lines. The focus is on procuring the lab with state-of-the-art diagnostic imaging equipment to visualize the arteries and the chambers of the heart to treat stenosis and cardiac abnormality which is fueling the cath lab market.

A number of Tier-II and Tier-III setups are looking for basic cath labs as viable solution for their low-volume setups. Some of them are setting up monoplane and biplane hybrid labs to offer multi-specialty operation theaters to patients. The market is dominated by the monoplane segment. However, biplane equipment is also gathering momentum and is also being purchased by government hospitals now - the six new AIIMS have all procured biplane cath labs. The growth in cath labs market is providing strong opportunities for existing and potential players to earn high revenues and increase their profits by advancing existing systems and devising new technologies.

Emerging Trends

Angiographic imaging system vendors are developing several new technologies to address emerging cath lab trends, including the need to reduce radiation dose, improve image quality, and enable advanced procedural image guidance. All three of these points have become increasingly important as more complex procedures are attempted in interventional cardiology cath labs and hybrid operating rooms.

New systems and technologies are being introduced to reduce dose and enhance visualization in the cath lab. The vendors are tailoring their systems into various models for specific specialties and at various price points depending on the degree of functionality. They are also offering software to enhance visualization of stents and other devices.

Advanced imaging systems. New imaging systems enable advanced 3-D imaging with rotational angiography, which uses a quick spin around the patient to create a computed tomography (CT)-like 3-D image of the anatomy. This can all be done tableside in the cath lab. Some systems allow these images, or CT, or magnetic resonance imaging (MRI) 3-D images, to be overlaid or fused with the live 2-D fluoroscopic images. This fusion technology is used with TAVR planning and navigation software to better guide precise device placement. Software also allows 3-D images to be integrated with EP electro-mapping systems to guide catheter ablation procedures without the need for live fluoroscopy, helping to reduce dose.

Reducing radiation dose with robotics. Physicians performing robotic percutaneous coronary intervention (PCI) no longer need to stand next to the cath lab table, exposing themselves to harmful radiation and orthopedic injury from prolonged use of heavy, leaded aprons and guards. Robotic PCI enhances safety through potential improvements in appropriate stent sizing and more precise device delivery, limiting longitudinal geographical miss. It reduces occupational hazards, predominantly with significant reduction in radiation exposure to the primary operator, as well as the ability to do the case ergonomically in a much superior position.

Better navigation aids. A key feature of newer digital angiography systems is the use of rotational angiography, in which the C-arm makes a quick rotation around the patient to create a CT-like 3-D image. Today's angiography systems offer software to take CT or MRI datasets that can be registered with the fluoro view. These features help identify if stents are fully opposed to the vessel wall, or to better visualize the results of bifurcation stenting. Real-time 3-D reconstruction and CT-like imaging tools are needed for vascular and neuro applications. A large number of users are using fractional flow reserve (FFR) and intravascular ultrasound (IVUS) with cath lab systems and getting these systems bundled with cath lab system during purchase.

Integration with hemodynamic systems and EMR. Two key requirements for today's cardiovascular information systems (CVIS) are solid integrations with both enterprise-wide electronic medical record (EMR) systems and the catheterization lab's hemodynamic monitoring system. In the catheterization lab, the hemodynamic monitoring system is at the core of all procedures, so there needs to be solid integration with the CVIS. Tight integration between the CVIS and the hemodynamic system eliminates the need to manually tabulate or re-enter data that is already stored in an electronic format. EMR integration allows all patient information from cardiology to flow into the EMR, so there is a single access point for patient data, and duplicate data entry is avoided.

Advances in adjunct pharmacotherapy. Alongside all devices available in the catheterization laboratory, adjunctive pharmacotherapy remains essential to optimize diagnostic and treatment strategies during both diagnostic and interventional procedures. Pharmacotherapy may indeed prevent potential complications especially in patients at high risk, besides helping physicians in managing emergency clinical scenarios. Many recent innovations have been made in developing new antiplatelet and anticoagulant drugs in the last few years, revolutionizing the antithrombotic therapy given to support percutaneous coronary intervention and managing acute coronary syndrome.

Challenges and Opportunities

Adoption of minimally invasive procedures, growing advent of technological advancements pertaining to catheter materials that prevent biofilm formation; growing prevalence of cardiovascular diseases, diabetes and urinary diseases; growing healthcare expenditures; and trend toward the use of single-use catheters and self-catheterization are offering potential opportunities.

Most of the district government hospitals still do not have cath labs. Many states and districts still have very low cath lab access. In the number of cath labs per coronary heart disease cases, India stands at one-tenth of developed countries like the United States. Government schemes and policy support are required to ensure access to all, as early access to a facility with cath lab can be the difference between life and death in many cases. More interventional cardiology and radiology seats and more trained staff is the need of the hour to catch up with rising disease occurrence and the vision of Healthcare for All.

Future Outlook

Cath lab of the future would include technologies that currently exist, including robotic systems, navigation technology that can position devices without radiation or contrast media, and coronary CT angiography. Integrating these technologies in the cath lab will create a much more robust management of coronary artery disease. With the advent of robotic-assisted percutaneous coronary intervention, interventional cardiology is poised to experience a tectonic shift. A major growth in the radiology segment and mixed- use interventional labs is also expected in the coming years.

The government will also play a major role in providing cardiac healthcare facilities to all. With the aid of modern technology and the expertise and commitment of doctors, the concept of mobile cath lab could be given a boost to provide cardiac catheterization services for early detection of heart ailments at primary health centers owing to the critical need for cost-effective and innovative solutions for cardiac treatment in remote rural areas.


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