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October 20, 2010 -- 5:00pm EDT Angioplasty Live! The photo above shows Dr. Andreas Gruentzig in his catheterization lab during a live course at Emory Hospital in Atlanta, where he conducted a number of broadcasts in the early 1980's. His purpose was to train cardiologists in this radical new procedure that he had invented in 1977: balloon angioplasty. Gruentzig was adamant that physicians needed to be well-trained and cautious when beginning to do these new types of procedures. Because he knew that unbridled expansion of his technique would result in complications and poor outcomes -- and that would stifle the development of this minimally invasive treatment for coronary artery disease. The years intervening have changed both the purpose and presentation of these live courses considerably. 1978 saw the first of these courses, when Gruentzig, then at University Hospital in Zurich, could not accomodate all the physicians who wanted to learn his technique via visits to his cath lab.
At last month's TCT meeting in Washington, 10,000 attendees watched more than 100 hours of live cases, beamed in from Germany, France and 17 other international sites -- and in high definition on a 150' screen! (photo above from PSAV Presentation Services.) Quite a change in a little over three decades. So the regulatory agencies and professional societies have become concerned that live courses, which have become the cornerstone of many highly-attended cardiology meetings, be done in an ethical, safe and rational manner; that they do not become merely showcases for new equipment, whose manufacturers have contributed to the bottom line of the meeting; that the safety and privacy of the patients involved are protected. These are valid concerns and the joint statement is a good touchstone -- all would be welcomed by Andreas Gruentzig. But the very early angioplasty courses, many of which I had the honor of producing and directing, were a bit different than today. As Dr. Richard Myler, who performed the first angioplasty in the U.S. (simultaneously with Dr. Simon Stertzer) says in the video below:
I created the video below to accompany a discussion of this topic during the 2009 CRT meeting in Washington, as part of the FDA Workshop. It gives a taste of what these early courses were like -- where the patients, instead of having their privacy protected, sat up proudly after the successful procedure and gladly waved with a smile to the audience of cardiologists, a group that would go on to make angioplasty the gold standard for the treatment of heart attacks.
(Disclosures: the creation of the above video was supported by an unrestricted educational grant from Abbott Vascular. Speaking in the video are John E. Abele, co-founder of Boston Scientific, Maria Schlumpf, Gruentzig's assistant, Dr. Spencer B. King, III, Dr. Richard K. Myler, Dr. Gary S. Roubin and Dr. Martin B. Leon. Music by Nell Shaw Cohen.) |
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Last
month saw the publication of a joint statement on: "
So
only months after he had invented the procedure, he invited 28
physicians to gather in the auditorium of the hospital and watch
him perform angioplasty on seven patients via a small
closed-circuit TV monitor (pictured on right). At that point Gruentzig
had only done 27 angioplasties...period! That event, and the subsequent
live courses that he did in Zurich
and then in Atlanta were the genesis of
a whole new specialty, interventional cardiology, and a whole new
type of therapy for
patients -- opening blockages, delivering heart valves, stopping
heart attacks as they are occurring(!) -- all without surgery,
without opening the chest, without using a heart-lung machine --
all done by inserting a catheter in the groin or arm artery.