His master’s art, Andreas Grüntzig’s approach to performing and teaching coronary angioplasty
Andreas Roland Grüntzig (1939-1985) was an accomplished clinician and an astute scientist. He was also a practical man endowed with dexterity, smartness, and common sense.
For him, performing a catheter intervention in contrast to surgery was like playing the clarinet in contrast to playing the piano. It was easier but it still required talent and proper training to become a professional. Playing the piano means using all ten fingers at the same time and having 88 keys to choose from for every single finger, not to mention the simultaneous work on the foot pedals. A clarinet also requires the use of all ten fingers but each finger has just a single (exceptionally up to five) allotted function. Clarinet players may forgive my not mentioning the importance of the mouthpiece. The analogy is just to make a point. The cardiac surgeon works three-dimensionally with every stitch, every cut, and every suture having to meet quality requirements and representing his or her level of art. Performing a catheter intervention, on the other hand, only permits one to advance, retract, turn right, or turn left, one, two, or at the most three different instruments at a time. Yet, while the surgeon has a true three-dimensional field of vision, a catheter operator has to imagine the third dimension looking at a two-dimensional black and white picture. The surgeon approaches things directly and one millimetre (mm) of motion equals 1 mm of effect. The catheter operator has to account for a time delay of his motion and a five centimetre movement at his end of the catheter may well translate into no or just a very small movement at the other end of the catheter inside the patient. Video gaming may come close to what an operator experiences during catheter interventions. Grüntzig, living before the video game era, trained with catheters on the kitchen table and started performing his intervention in the leg where inaccuracy and imperfection were more forgivable and less dangerous. Find out more ...