Andreas Grüntzig (1939–1985)
Experiencing the history of angioplasty
Early Life and Studies
Andreas was born on June 25,1939 in Dresden, East Germany. His father, Wilmar Grüntzig (1902-1945), Ph.D. in chemistry, was a writer, composer, and science teacher. His mother, Charlotta Zeugner Grüntzig (1907-1995), was a piano teacher and was devoted to her two children, Johannes and Andreas. In 1957, Andreas graduated with highest honors from the Thomas Schule in Leipzig. He left to join his brother Johannes in Heidelberg, leaving just before the Communist DDR government closed East Germany’s borders. He obtained his medical degree at Heidelberg University in 1964 and completed an internship in many different specialties, most notably at the Max Ratschow Klinik in Darmstadt, where he performed his first peripheral artery angiographies.
In 1969, Andreas obtained a job with Robert Hegglin, a renowned internal medicine specialist at the University Hospital in Zurich, Switzerland and settled in Zurich with his fiancée Michaela Seebrunner, a psychologist. Robert Hegglin unexpectedly died from an abdominal aortic aneurysm rupture three weeks later, and Andreas Grüntzig transferred to Alfred Bollinger’s angiology unit. He also trained in Josef Wellauer’s radiology department.
In 1971, Andreas met Eberhard Zeitler in Engelskirchen and was introduced to the Dotter technique (catheter-based dilation of peripheral arterial stenosis). Soon thereafter, his idea for a balloon catheter was born. Andreas received no support from federal funding agencies or the hospital, neither of whom approved of his ideas. He worked at home in the evenings and on weekends. It took him two long years with the help of Michaela, Maria Schlumpf, his research assistant and her husband Walter, an engineer, to create a functional, hand-made balloon catheter.
Maria Schlumpf working on a functional, hand-made balloon catheter.
In October 1973, he moved to the Division of Cardiology of the Kantonspital’s Medical Policlinic, headed by Prof. Wilhelm Rutishauser. During this time, he performed angioplasty procedures with the Dotter technique in peripheral vessels in patients in the University’s Department of Radiology. On February 12, 1974, he performed his first peripheral angioplasty using his new single-lumen dilatation catheter with a 4-mm balloon on a 67-year-old man admitted with incapacitating claudication caused by a severe femoral artery stenosis
On March 6, 1974, Andreas performed the first balloon angioplasty of an iliac artery stenosis. Andreas Grüntzig and Heinrich Hopff, Ph.D., a retired engineer, published their new balloon catheter concept and clinical findings from the first 15 patients. The Grüntzig balloon angioplasty procedure became known as ‘percutaneous transluminal angioplasty’ or PTA, referencing the terminology originally introduced by Charles Dotter.
Andreas filed patent applications on the balloon catheter concept in the U.S., Switzerland, Germany, France, England, and Japan.
Marko Turina, a cardiac surgeon in Zurich, created coronary stenoses in 16 dogs to enable Andreas Grüntzig to perform canine coronary angioplasties with his home-made balloon catheter. The first dilatation was performed on October 22, 1975.
Andreas Grüntzig attempted to perform his first PTCA on March 22nd, 1977 on a patient that the surgeons refused to treat. It was an opportunity to test it for the first time in the coronary circulation in humans and potentially show a credible alternative to coronary artery bypass graft surgery. Unfortunately, the guiding catheter was unable to reach the left main stem artery and the procedure could not be performed. The lesson was clear for Andreas Grüntzig: it was imperative to start a new technique with good indications and not with contraindications for another technique.
At the 1976 AHA meeting in Miami, Andreas presented a poster on his canine coronary artery dilatations. He met Richard Myler who was immediately attracted by his research. Richard Myler visited Andreas Grüntzig in Zurich and invited him to St Mary’s Hospital (San Francisco, USA) to perform intra-operative dilatations with the support of his cardiac surgeon, Elias Hanna. Four intra-operative dilatations were performed starting on May 9, 1977, verifying that his balloon was effective and safe.
In September 1977, Bernhard Meier referred a patient to Andreas. The patient was a 38-year-old man (the same age as Andreas), suffering from unstable angina with a positive stress test due to an isolated stenosis of the left anterior descending coronary artery (LAD). The patient enthusiastically accepted to be the first person treated using PTCA, allowing him to avoid coronary bypass graft surgery. Ake Senning, Chief of Cardiac Surgery encouraged and defended Andreas Grüntzig’s project—which was widely criticized—and promised to operate "if something happens".
On September 16th, 1977, the patient entered the cath lab. The chief of the cardiology department, the cardiac surgeon, the anesthesiologist, the cardiology and radiology fellows were present, as well as attentive and curious observers. Andreas Grüntzig catheterized the left coronary artery percutaneously via the right femoral artery using the Judkins technique. An arterial sheath was inserted in the left femoral artery, with the intention to perfuse the myocardium with a roller pump (via the central lumen of the balloon catheter) during the balloon inflation. However, the patient did not become ischemic; there was no need to start the roller pump; and the stenotic LAD artery was effectively dilated, thereby restoring distal myocardial blood flow without a need for supplemental perfusion. Thus, Andreas Grüntzig had made angioplasty an even simpler therapeutic procedure than originally envisioned.
Andreas Grüntzig had just realized his dream, and coronary angioplasty was now a reality. Happy with this successful outcome, Andreas Grüntzig called Richard Myler to tell him: « I’ve done it! »
Very quickly cardiologists from all over the world wanted to perform angioplasty.
With the increased number of ¨pilgrims¨ coming to see him working, Andreas Grüntzig organized television transmissions during live demonstration courses, something which had never been done before. Andreas Grüntzig organized his courses without support from the hospital administration. He was still surrounded by many critics in Zurich who thought his ideas were dangerous. Four PTCA courses were held in Zurich between 1978 and 1980.
After the 4th course, a passing of the torch took place between Mason Sones, Charles Dotter, Melvin Judkins and Andreas Grüntzig, symbolizing the knowledge transmitted across generations.
The American dream
Spencer King persuaded Andreas Grüntzig to contact Emory University in Atlanta, Georgia. After hesitating between Emory, the Cleveland Clinic, Harvard, Houston, Stanford, keeping a door open in Zurich and holding out hope for a position in Tübingen, Germany, Andreas finally decided to select Emory, which he joined in October 1980.
The first annual course in Atlanta was held in February 1981. More than 200 cardiologists from around the world came to see the brilliant teacher in action. The course lasted 3 and 1/2 days with one live teaching case per half day and, with each subsequent course, the momentum for angioplasty increased.
The year 1985 was disastrous for major pioneers of interventional cardiology. Melvin Judkins died from a myocardial infarction in January, followed by Charles Dotter who succumbed after a second coronary artery bypass surgery in February and, finally, Mason Sones, who died of lung cancer in August. Andreas Grüntzig remained ¨the only survivor¨.
Tragically, Andreas Grüntzig’s life ended all too soon. He and his second wife, Margaret Ann, were both killed in his private airplane, which crashed on October 27, 1985 between Sea Island and Atlanta, Georgia. The meteorological conditions were unfavorable due to the presence of a hurricane in the Gulf of Mexico.
Andreas Grüntzig, so careful with his patients, yet so sure of his own invincibility, took off against all advice in his recently purchased multi-engine aircraft. His pioneering spirit, legacy and passion will always live on through the continued evolution of what he created and the many cardiologists and innovators that he has inspired.
Video Resources: A tribute to Andreas Grüntzig
Courtesy of Angioplasty.org
Years ahead of his time, Andreas Gruentzig's vision of where angioplasty was in 1985, and where it was going to go, was prescient.
In clips from our interview with him, only weeks before his tragic death, Gruentzig discusses everything from total closures, “the ideal catheter,” and the need for additional non-balloon catheter systems to the importance of recognizing complications. His legacy is discussed by those who knew and worked with him: Gary Roubin, Geoffrey Hartzler, Spencer King, John Abele, and Richard Myler.