Interview
Martin B. Leon, M.D., Part I

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.
 
Martin B. Leon
TCT X, October 7-11, 1998
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
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
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.
 
Martin B. Leon
But the real concern is how to manage complications, or pseudo-complications. So when they see a complication by an experienced operator during the course of a live case, I think that the learning experience is enriched. They can take that decision-making process during complications and they can translate that to their own experiences more effectively than simply watching successful live cases.
 
Next installment: Dr. Leon's interview continues with a discussion of the device revolution of the 80's, leading to the current wave of "stent-mania".



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