Symposium Delves Into Ethics of Device Testing in Developing Countries

A. Pieter Kappetein, MD, PhD

Before new devices are released on the US market, they oftentimes undergo testing in developing countries. Because the devices are too costly to purchase and maintain, these countries cannot ultimately afford to use them.

A panel of experts will tackle the device-testing process during the International Symposium: The Ethics and Practicality of Using New Technologies to Treat Cardiothoracic Diseases in Different Parts of the World, which will be from 3:30 p.m. to 5:30 p.m. on Monday, January 25.

“Medical ethics committees are less stringent in developing countries, so it’s easy to go there, test devices, come back, and report that you had good results,” said A. Pieter Kappetein, MD, PhD, who will moderate this ticketed symposium, which will be followed by a reception.

During a panel discussion, Dr. Kappetein and international faculty from various specialties, including cardiothoracic surgery and medical ethics, will debate the ethics of testing devices in countries where the technology likely will not be dispersed.

“Some may argue that these countries, which otherwise don’t have access to such medical treatment, at least now have some treatment,” said Dr. Kappetein, who is a Professor of Cardiothoracic Surgery at Erasmus Medical Center in Rotterdam, The Netherlands. “It’s an ethical debate, especially when unsuccessful results are not reported.

“You have to move the field forward, but when is the time right, when do you have enough evidence that you can do this, and which patient population should participate?”

The panel will respond to these questions with regard to new technologies for mitral valve disease, including transcatheter mitral valve repair and replacement devices. Symposium speakers also will talk about other evolving treatment approaches for mitral valve disease, endocarditis, and rheumatic heart disease in relation to their viability for use in treating cardiothoracic diseases in underdeveloped parts of the world.

During an examination of the modern era of endocarditis treatments, presenters will share emerging trends in infective endocarditis and different treatment approaches in Japan and South Korea.

Dr. Kappetein, an STS International Director and Secretary General of the European Association for Cardio-Thoracic Surgery, said one speaker will discuss a trial out of Korea, which compared operating early on patients and use of conventional treatment on patients who had infective endocarditis.

“Whether you should operate early or not is always a question. If you wait a little while and give patients antibiotics, your repair may last longer,” Dr. Kappetein said. “On the other hand, if you wait too long, the patient may deteriorate and be more difficult to repair.”

One presentation, Rheumatic Heart Disease: Between a Rock and a Heart Place, is a play on words for the hard calcium found in the mitral ring of patients with rheumatic valve disease, but this serious discussion will highlight the challenges of repairing and replacing the mitral valve. Although rare in the United States, rheumatic heart disease is prevalent in sub-Saharan Africa, Asia, and other developing countries.

“We can exchange information and learn from others in developing countries. In Asia, where much of the population has rheumatic heart disease, they have developed treatment techniques,” Dr. Kappetein said. “We always like to cover a technique in cardiothoracic surgery that is of interest to many people all over the world.”