Interventional cardiology in Argentina has been shaped by visionary minds who have marked milestones in the evolution of our specialty. Among them, Dr. Luis de la Fuente stands as a true pioneer, a professional whose career has transcended borders, making significant scientific contributions to the development of cardiovascular interventions.

Recently, the Argentinian College of Interventional Cardiologists (CACI) paid him a well-deserved tribute at the National Scientific and Technical Research Council of Argentina (CONICET), thus recognizing his invaluable contributions to cardiovascular medicine. His legacy spans decades of innovation, research, and clinical excellence, and he was involved in some of the most significant milestones in our field, globally. The event also held the official presentation of the book “Cardiología intervencionista” (“Interventional Cardiology”), authored by Dr. David Vetcher and Dr. Luis de la Fuente himself. Dr. Vetcher played a key role in organizing this gathering and in writing this historical account of interventional cardiology in Argentina.

Dr. de la Fuente is not only a visionary; he also had a starring role in the first experience with the Quanam1 drug-eluting coronary stent, a revolutionary advancement that transformed the treatment of coronary artery disease. At a time when restenosis limited the benefits of angioplasty, his involvement in the development and application of this technology demonstrated his innovative spirit and commitment to advancing the specialty.

Furthermore, his work in cell therapy2 applied to cardiology led him to collaborate with Dr. Simon Stertzer, one of the pioneers of coronary angioplasty, in the injection of stem cells into the myocardium. This experimental approach aimed to explore new frontiers in myocardial regeneration, contributing knowledge that continues to evolve in the field of regenerative cardiovascular medicine even today.

His contributions were not limited to coronary interventions. He actively participated in the development of innovations that impacted significantly on nephrology and structural cardiology. One of his most notable advancements is the concept of “neo-artery”3, which is crucial for the creation of arteriovenous fistulae for dialysis. This innovation represents a major step forward in optimizing vascular access for hemodialysis patients, improving the functionality and longevity of fistulae.

Another one of his most significant scientific contributions is the re-evaluation of the venous sinus as the “fifth major cavity of the heart,”4 alongside Dr. Adrián Barceló. This concept expands the anatomical and functional understanding of venous circulation in cardiac hemodynamics. It allows for new perspectives in the assessment of heart failure and coronary venous flow, reinforcing the importance of the coronary sinus in cardiovascular pathophysiology.

Trained in Portland, Oregon, USA, Dr. de la Fuente spent a fundamental part of his career at Sanatorio Güemes, where he had the privilege of working alongside Dr. René Favaloro, the father of myocardial revascularization surgery, and Dr. Carlos Bertolasi, a master of clinical cardiology. His connection with Dr. Favaloro symbolizes the convergence of cardiovascular surgery and interventional cardiology, two disciplines that, rather than competing, have evolved synergistically to provide patients with the best therapeutic options.

This aspect of his career highlights his versatility and ability to integrate clinical knowledge with technological innovation leadership. His focus has always been on finding solutions to improve patient quality of life, a guiding principle throughout his professional journey.

On a personal level, I had the opportunity to work and be trained alongside Dr. de la Fuente at Sanatorio Güemes in the late 1980s, during the early days of acute myocardial infarction (AMI) interventions and femoral angioplasties. That period was crucial for my growth as a cardiologist. His clinical approach and vision for interventional cardiology left a profound impact on my learning. He was an example of dutifulness and discipline in our specialty.

The recognition awarded by CACI at CONICET is a testament to the profound impact Dr. Luis de la Fuente has had on interventional cardiologists in Argentina. His legacy lies not only in the technical advancements he helped implement but also in his lasting influence on future generations of interventional cardiologists.

Consensus on Percutaneous Aortic Valve Replacement: A Step Forward
in Interventional Cardiology Training in Argentina

The Consensus on Percutaneous Aortic Valve Replacement5 is a milestone that accounts for the strengthening of interventional cardiology training in Argentina. This document systematizes the current evidence on transcatheter aortic valve replacement (TAVR), while providing practical guidelines adapted to the specific characteristics of our region. Given the exponential growth of structural cardiology in our country over the past decade, these recommendations based on the best available evidence are essential to ensure quality, safety, and equitable access to this therapy.

A detailed reading of the document reveals that one of its fundamental pillars is the consolidation of the Heart Team as the center for decision-making in patients with severe aortic stenosis. Multidisciplinary assessment has been shown to improve clinical outcomes by integrating the expertise of clinical cardiologists, interventional cardiologists, cardiovascular surgeons, imaging specialists, and geriatricians. The recommendation that every hospital performing TAVR should have a trained Heart Team reinforces the need for a collaborative approach, steering away from isolated decisions and focusing on comprehensive patient assessment.

Another key point that I support is the assessment of frailty in elderly patients, a factor often underestimated by colleagues that has a significant impact on treatment selection and post-TAVR outcome predictions. The acknowledgment of objective scales such as Fried, Rockwood, or the Short Physical Performance Battery (SPPB) is an important contribution to preventing interventions in patients with low chances of clinical benefit. In this regard, the explicit mention of futility as a contraindication for TAVR highlights the importance of proper patient selection, particularly in emerging countries where healthcare resources are limited and access to valve prostheses remains a challenge.

The consensus also clearly outlines the indications and contraindications for TAVR, incorporating the latest international recommendations while adapting criteria to Latin America. It reinforces the concept that TAVR and surgical aortic valve replacement (SAVR) are not mutually exclusive but rather complementary treatments, with differentiated indications based on surgical risk and patient anatomy.

From a technical perspective, the document underscores the importance of CT angiography as a key tool in procedural planning. The selection of the appropriate prosthesis size and of the right vascular access are crucial steps in reducing complications, improving implantation, and optimizing hemodynamic outcomes. This emphasizes the need to assess not only the aortic annulus but also the left ventricular outflow tract, the height of the coronary ostia, the sinuses of Valsalva, and the sinotubular junction, as these factors directly influence procedural success.

Regarding prosthetic valve selection, the consensus provides a detailed description of the different available scaffolds, including balloon-expandable and self-expanding valves, highlighting their characteristics, advantages, and limitations. This information is particularly valuable for interventional cardiology trainees, as it enables a more rational and individualized approach when selecting the most suitable prosthesis for each patient and specific anatomy.

The document also clearly addresses vascular access options, establishing the transfemoral route as the preferred approach, while also recognizing the importance of alternative access routes such as the subclavian, carotid, or transcaval access in patients with unfavorable anatomy. The consensus emphasizes the need for thorough vascular assessment using imaging techniques, as well as the use of appropriate vascular closure devices to minimize complications.

Another critical aspect covered in the consensus is the management of complications associated with TAVR, including paravalvular regurgitation, conduction disturbances (such as need for a permanent pacemaker), vascular complications, and stroke. By identifying predictors of complications and establishing evidence-based management strategies, the document contributes to improving patient outcomes and reducing variability in clinical practice.

Finally, the consensus introduces updated recommendations on antithrombotic therapy after TAVR, an ever-evolving field. The document emphasizes a preference for single antiplatelet therapy in most cases, avoiding more aggressive alternatives that may increase bleeding risk without providing a clear benefit in thrombotic event prevention.

In summary, this consensus is an essential read for our interventional cardiology community. Its elaboration reflects the commitment of the Argentinian College of Interventional Cardiologists (CACI) and the Argentinian Journal of Interventional Cardiology (RACI) to continuous education and the standardization of best practices in structural heart disease.

Dr. Carlos Fernández Pereira, PhD, FACC, FESC, FSCAI
Editor-in-Chief, Argentinian Journal of Interventional Cardiology (RACI)
cfernandezpereira@centroceci.com.ar

1. Fuente L, Miano J, Mrad J, et al. Initial results of the quanam drug eluting stent (quads‐qp‐2) registry (bardds) in human subjects. Catheterization and Cardiovascular Interventions 2001;53(4):480-488.

2. Fuente L, Stertzer S, Argentieri J, et al. Transendocardial autologous bone marrow in myocardial infarction induced heart failure, two-year follow-up in an open-label phase I safety study (the tabmmi study). EuroIntervention 2011;7(7):805-812.

3. Wystrychowski W, Garrido S, Marini A, et al. Long-term results of autologous scaffold-free tissue-engineered vascular graft for hemodialysis access. The Journal of Vascular Access 2022;25(1):254-264.

4. Barceló A, Fuente L, Stertzer S. Anatomic and histologic review of the coronary sinus. International Journal of Morphology 2004;22(4).331-338.

5. Damonte JI, Garmendia CM, Cal M, et al. Actualización 2024 del Consenso sobre Implante Valvular Aórtico Percutáneo del Colegio Argentino de Cardioangiólogos Intervencionistas. Revista Argentina de Cardioangiología Intervencionista 2024;15(4):166-187.

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