Thirty years after the first transluminal percutaneous coronary angioplasty, interventional cardiology has reached maturity. Coronary stenting has become a routine practice in all catheterisation laboratories and is currently the most frequently used method of revascularisation in patients with coronary artery disease. Besides, percutaneous coronary intervention is acknowledged for saving lives in emergency scenarios such as ST elevation myocardial infarction when it is performed in a timely manner. Our speciality has not stopped innovating, and a new generation of intracoronary stents will soon appear with the aim of increasing safety while offering the high efficacy demonstrated by those first generation of drug-eluting stents. For all these reasons, coronary stent implantation is currently an accepted and standard therapy in the medical community.
Furthermore, innovation in interventional cardiology extends well beyond coronary stenting. In this regard, I would highlight the following areas of interest: new intravascular imaging and physiological techniques; development of coronary devices to support stent implantation; and, more recently, treatment of structural (either congenital or acquired) heart disease. Most of these technical advances will soon be incorporated into our curriculum for training interventional cardiologists. At the same time, most currently accredited and practising interventionalists will need to incorporate these new developments within their catheterisation laboratories.
The issue facing these physicians today is how to gain experience in these new techniques and what can be done to make their learning curve as short as possible. Results from well experienced operators in a specific technique are commonly published in peer-reviewed journals. However , there is normally a lack of detailed description of procedures in these papers. Thus, “learning the technique” remains only within the scope of those dedicated courses where live cases are performed.
The aim of this work is to provide the reader with a book that is at the same time both clinical and yet practically oriented, covering interventional techniques of special interest to the interventionalist, and focusing on those common problems/dilemmas that beset the cathlab operator. The primary goal is to describe those ‘tips and tricks’ that come from a seasoned operator’s experience, using their point-of-view to illuminate the learning process of these new technologies which go beyond stenting in a way that is clear, precise and relevant... something the reader will not find in the average textbook.
The content of each chapter includes an introduction to a device or anatomical problem, a step-by-step description of the procedure – fully illustrated – followed by a description of potential risks and complications as well as methods of preventing or treating them.
The book is divided into three parts, and includes 26 chapters.
Part I (six chapters), deals with diagnostic techniques. Here, the two introductory chapters (on intravascular ultrasound and fractional flow reserve) are followed by new developments in the field such as virtual histology, optical coherence tomography, electromechanical mapping and intracoronary thermography.
In Part II (15 chapters), therapeutic techniques are discussed in detail. The description of coronary devices used in the successful implantation of coronary stents such as rotablation, proximal and distal embolic devices, thrombectomy and ventricular assist devices are described in this section. New developments in groin closure devices and retrieval techniques are also considered. Recent advances in the treatment of coronary chronic total occlusions, either via the antegrade or the retrograde approach, are discussed in detail by leading international experts from the Japanese school. Also, in this section, four chapters are dedicated to the percutaneous treatment of congenital heart disease including atrial septal defect, patent foramen ovale, persistent ductus arteriosus and aortic coarctation. Trans-septal puncture, as a technique that may see a revival in its use in the near future due to new valvular treatments, is also considered in a dedicated chapter. Finally, a chapter is devoted to the treatment of paravalvular leaks that represent a complex acquired disease with a highly challenging treatment.
Part III (five chapters), highlights the most recent and popular developments in the treatment of percutaneous valvular treatment. In particular, three chapters are dedicated to transcatheter aortic valve replacement, one to mitral valve repair and, one to pulmonary valve replacement.
It is with pleasure that I acknowledge all the contributors to this book – specifically selected for being internationally renowned experts in each field – who have made it such a valuable addition to our literature. They accepted my invitation with great enthusiasm, and provided outstanding work with the aim of sharing their experiences with the entire medical community. I am truly grateful and indebted to them. It is due to the superb quality of their work that the European Association of Percutaneous Coronary Intervention (EAPCI), a registered branch of the ESC, has endorsed this educational material, which will be promoted on the ESC/EAPCI website.
I sincerely believe our readers will not only enjoy this book, but learn – as I did when preparing this work – from all these chapters.