HeartNet

Cardiac Catheterization and Intervention:The Past, Present and Future Focusing on Southwest Virginia

Timothy C. Ball, MD, PhD

Assistant Professor of Medicine

Coronary, Structural and Peripheral Intervention

Medical Director Cardiac Catheterization Laboratory

Associate Program Director Cardiovascular Disease Fellowship

Virgina Tech Carilion School of Medicine

9/25/2015

Disclosures

• I have no relevant financial disclosures.

Objectives

• To present a historical overview of cardiac catheterization and coronary intervention

• To present the evolution of cardiac catheterization and intervention in Southwest Virginia

• To touch briefly on the currently available endovascular therapies

• To peer into the bright and potentially unlimited future of cardiac intervention.

Areas of Evolution

– Coronary Artery Bypass Surgery– Coronary angiography, Coronary artery intervention – Valve Surgery– Trans catheter Valve Replacement (TAVR)– Surgical management of Congenital heart disease– Catheter based management of Structural heart disease– Electrophysiology Studies, Ablations, Pacemakers and

ICDs– Surgical management of Peripheral Arterial Disease (PAD)– Endovascular management of PAD– Mechanical support of the failing ventricle– Endovascular Management of Stroke

• I will try to present a contemporary timeline of the evolution of cardiac catheterization and coronary intervention the current state of the art interventional cardiac catheterization laboratory and then speculate on the lab of the future.

Timeline

• 1929 1st cardiac catheterization of a Human – Dr. Werner Forssman, Eberswald Germany

• 1941 1st cardiac ouput – Andre Cournand and Dickins Richards

• 1953 Seldinger percutantous approach introduction of catheters. – Sven-Ivar. Actaradiol (39) (5): 368-376

• 1953 1st open heart operation with bypass – John Gibbon at Thomas Jefferson Hospital

Philadelphia

Timeline

• 1958 Selective coronary angiography– Mason Sones – accident complicated by VF

Texas Heart Inst J. 29(1):10-14.

• 1964 Dotter Technique– Charles Dotter

• 1967 – Rene Favaloro – first SVG bypass angiography, Cleveland, OH

• 1967 –Commercialization of Judkins catheters

Sones and the 11 inch Image Intensifier used for the First Coronary Arteriogram

Cine Frame of the First Right Coronary Mason Sones October 30, 1968

Cine frame taken by F. Mason Sones, MD, of the first aortocoronary saphenous vein graft inserted by Rene

Favaloro, MD.

Dr. Mason Sones, at left about 1960, performing early coronary angiography at the Cleveland Clinic. Sones, who was known for wearing a V-neck T-shirt in the operating room and rarely putting down his cigarette, had a habit of getting out of his seat and shouting at colleagues during medical conferences when he disagreed with their research findings or opinions. "You need to study the heart that's where all the excitement is," he told his fellow, Earl

Shirey, in 1953

Timeline

• 1973 Gantries with Rotating U arms• 1974 - Adreas Greuntzig – 1st peripheral balloon

angioplasty• 1977 – Greuntzig, Myler and Hanna – 1st

coronary balloon angioplasty, San Francisco.• 1977 – Adreas Greuntzig – 1st coronary balloon

angioplasty (PTCA) in an awake patient, Zurich• 1978 – Myler and Stertzler – 1st PTCA in the U.S.• 1980 – Guiding catheters introduced.

Timeline

• 1982 Over the wire systems and steerable guide wires.

• 1986 1st coronary self expanding wall stents Jacques Puel and Ulrick Sigwart Toulose, France

• IVUS• 1989 – Palmaz-Schatz stent developed • 1992 First cath and PCI from the radial approach

– Dr Ferdinand Kiemeneis Driven by an effort to reduce bleeding complications from femoral access with post procedure anticoagulation

Timeline

• 1994 Palmz-Schatz BMS stent approved by FDA for use in the US

• 2003 Cypher DES approved by FDA • 2004 Taxus DES approved by FDA

Timeline

• 1997 > 1 million angioplasties worldwide • 1999 85% of patients with PCI received

stent• 2001 2 million angioplasties worldwide

Timeline

• 1977 to 1982 Balloon Angioplasty– 63% Success rate– 24% In hospital CABG rate– 5% Myocardial Infarction rate

• 1985 to 1986 Bare Metal Stent– 82% Success rate– 6% CABG rate– 30 to 35% Restenosis rate

• 2003 – Cypher DES approved – 3.2% Restenosis rates

Structural Approvals

• ASD closure• PFO closure• PDA closure• Edwards balloon expandable aortic valve• Medtronic self expanding aortic valve• Mitraclip• Watchman left atrial appendage ocluder• Ethanol Septal Ablation• VSD occluder

Helmuth Hertz and Inge Edler The First Echocardiograph

Southwestern Virginia Cath Labs

• CRMH*• Salem VA• Lewis Gayle• Lynchburg• CNRV*• Montgomery Regional• Martinsville• Bluefield Regional*

* HeartNet Hospitals

Carilion Roanoke Memorial Hospital

• Date cath lab first opened under the direction of:  – 1972 Dr. Phillip Shiner

• First coronary angioplasty:   – 1985 Dr. Phillip Shiner and Dr. John Starr

• First coronary stent:– 1991

• First rotational atherectomy– 1995

• First pacemaker:

• First ICD:– 1995

• First Aflutter Ablation – 1988

• Procedural capabilities: – Diagnostic cath– PCI– Pacemaker Implantation– ICD Implantation– Open Heart Surgery

Lewis Gayle

• Date cath lab first opened under the direction of: 

• First coronary intervention:   

• First pacemaker:

• Procedural capabilities: – Diagnostic cath– PCI– Pacemaker Implantation– ICD Implantation– Open Heart Surgery

Salem VAMC

• Date cath lab first opened under the direction of:  – 1984

• First coronary intervention:   – 2002

• First pacemaker:

• Procedural capabilities: – Diagnostic cath– PCI– Pacemaker Implantation

• Year switched to digital 1997

Community Hospital

• Date cath lab first opened under the direction of: 

• First coronary intervention:   

• First pacemaker:

• Procedural capabilities: – Diagnostic cath– PCI– Pacemaker Implantation

HeartNet of the Virginias Est. 1989

•1989Bath County Community HospitalBedford County Memorial HospitalBluefield Regional Medical CenterFranklin Memorial HospitalGiles Memorial HospitalRadford Community HospitalRoanoke Memorial Regional Heart CenterTazewell Community HospitalWythe County Community Hospital

1991Stonewall Jackson Hospital

2000 Pocahontas Memorial Hospital

2000 Princeton Community Hospital

2013 Greenbrier Valley Medical Center

Bluefield Regional Medical Center

• Date cath lab first opened under the direction of:  – August 1989

• First coronary intervention:   – October 2012

• First pacemaker:

• Procedural capabilities: – Diagnostic cath– PCI– Pacemaker Implantation– ICD Implantation– Open Heart Surgery

• Date cath lab first opened under the direction of:  – 1990 Dr. Barnett, Dr. Wyne, Dr. Happell & Dr. Crafford

• First coronary intervention:   – March 27, 2015 Dr. Shin lee Tan

• First pacemaker:– May 1990 Dr. Uzair Wyne

• First ICD:– July 24, 2013 Dr. Jose Rivero

• Procedural capabilities: – Diagnostic cath– PCI– Pacemaker Implantation– ICD Implantation

Danville

• Date cath lab first opened under the direction of: 

• First coronary intervention:   

• First pacemaker:

• Procedural capabilities: – Diagnostic cath– PCI– Pacemaker Implantation– ICD Implantation– Open Heart Surgery

Memorial Hospital Martinsville

Martinsville

• Date cath lab first opened under the direction of :  – Jan 1992 Dr. Nayan Bhattt

• Date of coronary intervention: – 1993 Dr. Robert McQueen

• Date of first pacemaker in the cath lab: – 2003 Dr. Dinesh Bhatt

• Procedural capabilities: – Diagnostic cath– PCI– Pacemaker Implantation– ICD Implantation

Cardiac Catheterizations Performed in Virgina

Spectrum of Structural Heart Disease