A guide through the evolution of interventional cardiology
Philippe Gaspard, an interventional cardiologist with over 35 years’ experience, was a firsthand witness of angioplasty’s early years. In his book “The History of Coronary Angioplasty” the author guides us through the field’s evolution while offering personal insights into the “paradigm shift” that followed the work of Andreas Grüntzig.
Could you briefly tell us how you came to cross paths with Andreas Grüntzig?
Andreas Grüntzig’s first dilatation took place in September 1977, around the same time I started my cardiology residency programme. I performed my first coronary angiography in 1978 and my first coronary dilatation three years later. At the time, A. Grüntzig was known as “a German practitioner making new but dangerous procedures that often ended in surgery”. I remember thinking that I needed to witness this procedures myself and not just settle with the stories we were told.
I first got to meet him in November 1980 at the American Heart Association meeting in Miami and was immediately fascinated by his extraordinary presence. A certain elegance emanated from his speech, yet his approach remained simple: he had the ability to easily and effectively connect with the audience.
After this first meeting you were able to take part in several of his courses. How do you recall these experiences?
The first A. Grüntzig course I attended in 1981 was also his very first course in the USA. Around 200 physicians had come from all four corners of the world to experience A. Grüntzig’s novel idea: Live demonstrations. On-screen, we could see him performing and handling complications from the cathlab while simultaneously interacting with us. His approachable demonstration method, tremendous communication skill and remarkable yet humble personality made it easy for us to enter his new world.
I attended three more of his courses from 1982 to 1984. By 1985 and 1986 I had also had the chance to witness the methods of Geoffrey Hartzler—who enlarged A. Grüntzig’s initial indications for dilatations—resulting in a complementary learning experience. They were both exceptional professionals presenting two different approaches to treat percutaneously coronary artery disease.
You witnessed the field’s historical shift from “breaking new ground” into a “transformative approach”. When and how exactly do you think this shift took place?
At the very beginning A. Grüntzig had to be cautious, patient and persevering; he was inventing a new technique fiercely opposed by the cardiologists of the time. Ake Senning, the Swedish cardiac surgeon working with him in Zurich, Switzerland, played a major role in the acceptance of these new techniques. At the time, every dilatation had to be performed under the watch of a stand-by cardiac surgeon, ready to intervene in case of major complication. I believe one of the major turning points in the history of our field occurred when surgeons began to transfer transferring highly complicated cases and fragile patients to interventionalists. We treated these complex cases with success, and realised we were able to work without the support of a surgical stand-by team.
The second major historical shifting tide happened once we started to intervene at the acute phase of myocardial infarction. This contributed to change the surgeon/interventionalist dynamic. Both fluctuations were, of course, accompanied by a notable improvement in the equipment and devices offered by the industry.
How did the idea of writing this book first occurred to you?
When I first started this project, I was interested in learning what was it that led A. Grüntzig into developing balloon angioplasty. I wanted to know how it happened, to understand the different stages he had to go through. Furthermore, I have always been fascinated by history, particularly that of my field. I strongly believe that the knowledge of our past can help us get a deeper understanding of our present and better anticipate our future: it’s a sort of continuum.
Could you briefly guide us through the creative process?
Working with colleagues was fundamental. The book was based in my encounters with A. Grüntzig and G. Hartzler in the 1980’s, but, most importantly, it was nourished by my colleagues. There is and has been a sort of companionship between all the “early interventionalists” here in France. For a very longtime we have been gathering to discuss our cases, exchange our experiences and share our difficulties. This book was definitely a team effort.
To whom is your book primarily addressed?
I first wrote this book with cardiologists in mind, as well as nurses and other members of the cathlab. The book is also addressed to those representatives of the industry interested in the history of our field. Only few cardiologists still practicing today had the chance to meet A. Grüntzig. Yet, young practitioners are very keen to know more about him, and are fascinated with the history of the field. This book is also meant for them.
Which would you say are the lessons that readers should be able to get after reading your book?
I believe the major lesson is to “stay simple”. The more we try to complicate our methods, the more we take risks. Another lesson is to “be humble”; always think about the patient and treat within the best conditions available. In the book I also highlight the importance of teamwork. Cardiologists, nurses, imaging specialists, young practitioners—in our profession, working together is fundamental. Finally I would point out the importance of sharing our experiences and analysing our complications, all with the final outcome of improving our daily practice.
You have been one of the major actors of the 40 years of angioplasty expo. Why would you recommend your colleagues take part in the expo?
One of the main reasons is to understand A. Grüntzig’s scientific procedure. In fact, what I believe to be extremely interesting about his work is the fact that he would carefully analyse and deploy every single one of his innovations with the future in mind. He would always measure their mid- and long-term impact.
It is also important to remember that A. Grüntzig did not act alone. His cathlab team, peers around the world and close relatives played a major role in his path to success. I believe the Expo will highlight this team effort, and remind us how fundamental it is in our profession.