Cardiac Surgery With Percutaneous Interventional Backup
A Paradigm Shift
Interventional cardiology is now acknowledged as a discipline of medicine. It has all the essential ingredients of a medical subspecialty, including an Accreditation Council for Graduate Medical Education-accredited training program and an American Board of Internal Medicine board examination with certification. What is remarkable is the brief time over which these milestones have been achieved. Within the course of the careers of many of our peers, interventional cardiology did not even exist.
Interventional cardiology is a young discipline still being refined. The first coronary angioplasty was done in 1976, only 28 years ago. Compare this brief life span with the 16 years of formal education now required to train an interventional cardiologist. Nevertheless, memories are short and interventional cardiologists exist today who do not recognize the name of Andreas Gruentzig, who with the assistance of his wife Michalia and Walter and Maria Schlumpf crafted the first balloon catheters on Gruentzig’s kitchen table.1 Andreas was a pioneer and a true clinician–investigator. He was careful with the initial application of coronary balloon angioplasty, limiting its use to highly selected patients under a strict protocol that was designed to ensure safety and demonstrate the effectiveness of this revolutionary procedure.
Just as much as coronary disease was the target for this innovation so was coronary surgery. The motivation to develop percutaneous transluminal coronary angioplasty was to achieve coronary revascularization in a nonsurgical manner. In fact, the first published series of patients who were treated with this technique was entitled “Nonoperative dilation of coronary artery stenosis-percutaneous transluminal balloon angioplasty.”2 Then, cardiac catheterization was well established as a minimally invasive technique to obtain diagnostic information about cardiac anatomy and function, but aside from establishing atrial septal communication in congenital heart disease, catheterization had no real therapeutic role.
During a relatively short period of time, …