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October 20, 2010 -- 5:00pm EDT

Angioplasty Live!
Andreas Gruentzig in the Cath LabLast month saw the publication of a joint statement on: "The Use of Live Case Demonstrations at Cardiology Meetings" -- from the SCAI, ACC, HRS, ESC, SOLACI et al. The subject at hand was the proper and ethical use of live angioplasty cases that were being broadcast around the world as a physician training tool.

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.

closed-circuit TV control room 1978So 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.

TCT 2010 meeting

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:

"No one, to my knowledge, had ever taught a medical technique in front of a live audience when we ourselves were just infants in the technique itself. We were learning it, and there were people in the audience watching us do it, live!"

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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