This is part one of our interview (originally posted February 2, 1998)
with Martin B. Leon, M.D., Director of Cardiovascular Research and
Education for the Cardiology Research Foundation and Course Director
for the annual Transcatheter Cardiovascular Therapeutics (TCT), the
most widely attended interventional meeting in the world.
 
This
year's TCT meeting
will be held on October
7-11 in Washington, DC
Over 6,800 participants were at last
year's TCT. This
year's course is being held October 7-11 and will mark the 10th
annual meeting of TCT. One feature of this course is the satellite
transmission of live cases from around the world. Dr. Leon started
working in interventional cardiology while affiliated with the National
Institutes of Health at a time when angioplasty was in its infancy.
Dr. Leon also appears in our recently completed video documentary,
"PTCA: A History".
  Access previously posted interviews.
Q: You first started in this field in the early days of angioplasty.
How was the procedure looked upon in the U.S.?
Martin
B. Leon, M.D.
Washington, DC
Leon:
The climate was hostile, antagonistic, disbelieving. I think that
surgeons, internists, non-cardiologists felt that this was a very
bizarre way to treat patients, that mechanical balloon barotrauma
could not achieve durable results and could not achieve safe initial
results. So skepticism would be an understatement of the overwhelming
tide of sentiment in the early days.
 
Q:
How did that turn around? What changed? Leon: I think it took many many operators, a collection of data.
It was the original NHLBI Registry where there was a careful prospective
consecutive case enrollment, and Dr. Kent at that time ran the Registry,
so I was close to that data set. We began to see the evolution of
both technique and the improvement in results. And I think that
in the early 80s, there became more and more believers and the tide
began to turn from one of skepticism to one of, not full acceptance,
but at least tolerance of this new technique.
 
Q:
The concept of the demonstration course as an educational tool started
with Andreas Gruentzig in Zurich. Do you think that method of teaching
is still efficient?
 
Gruentzig
conducting live
demonstration course in Zurich — 1980
Leon:
I think you're certainly correct that Andreas was the pioneer of live
demonstration courses for coronary angioplasty. This technique, this
discipline cannot be taught in classrooms. It's a very practical,
intuitive, user-oriented technique. The only way to get a feel for
what's happening, to understand the concept of managing on-line decision-making,
management of complications, the complex interplay between the patient
and the physician, it's best observed, I think, on a practical level,
by watching experienced operators in the format of live cases. Now
there are many other ways of teaching this discipline, and we strongly
believe that that's one vehicle, but an important and central vehicle
to try to expand the knowledge base rapidly in how to apply new techniques.
  Q: The other way to show the procedure is through previously videotaped
cases.... Leon: I think there is a difference between a taped versus a live
course. We've gone through complex discussions about which is preferable.
I think there is a role for taped courses, but taped courses are almost
by definition, scripted. The outcomes to a certain extent are known.
They can be more time-efficient than live courses, but there's nothing
like the idea of literally being in the cath lab or in the operating
room with the operator and being involved in a real-time format in
making decisions.
  Q: Do you think that part of the interest in a live course is the
expectation that something unexpected may happen, that something may
go wrong?
Leon:
I think the drama of a live course is certainly a component of it.
I think that people don't "crave" to see complications, and obviously,
each one of the interventional operators feels most comfortable with
successful results.
 
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