FROM THE EDITOR
Peter C . Block , MD
Editor-in-Chief , CardioSource WorldNews : Interventions
Meet the Editor
CardioSource WorldNews : Interventions is excited to announce the newest member to our team : Peter C . Block , MD . In this interview , Dr . Block shares his thoughts on interventional cardiology and what he hopes CSI readers can anticipate moving forward .
What is your background as an interventional cardiologist , and what drew you to this specialty ? I had just taken over as chief of the catheterization laboratory at the Massachusetts General Hospital ( MGH ), Boston , MA , when , in early 1976 , Andreas R . Grüntzig , MD , visited . He was doing balloon angioplasty in femoral arteries , and we talked about the possibilities of doing the same in the coronary circulation . After he did his first coronary case in Sept . 1977 , only about six or seven “ catheterizers ” ( there were no “ interventionalists ”) here and in Europe began to look for appropriate patients . The first MGH case was done in June 1978 . It was an exciting time — those who believed in the technique and did their first cases called one another after nearly every case to compare thoughts and experiences . We all met in Zurich , Switzerland , that summer to tally up the total case numbers and our outcomes . I remember that nearly one in four patients was taken urgently to the operating room for coronary artery bypass graft surgery ! The complications made for a lot of skeptical coronary surgeons , but the successes were amazing . Shortly before that meeting in Zurich , an unconvinced surgical colleague of mine challenged me to show how angioplasty “ worked .” That challenge sent me to the animal lab and to post-mortem studies that helped reveal the mechanism of angioplasty , and it began my academic career in cardiology .
Then , in 1979 , the handful of coronary angioplasty operators who were doing cases around the world met at the National Institutes of Health to start the National Heart , Lung , and Blood Institute Percutaneous Transluminal Coronary Angioplasty ( NHLBI PTCA ) Registry , which established the first database for PCI and helped expand the use of the technique . With better technology and experience , complications were reduced . Balloon aortic and mitral valvuloplasty followed in the early 1980 ’ s , along with transcatheter atrial and ventricular septal closure , and this new field captured my interest .
I plan to expand the content of CSI so that more groups of interventionalists ( and their colleagues ) will have a voice .
Coronary angioplasty had become mainstream by then ( remember it was all “ plain old balloon angioplasty ” as stents were not developed till the early 1990 ’ s ) and the emerging technologies that allowed transcatheter treatment of mitral and aortic stenosis were simply too intriguing to ignore . We , at the MGH in conjunction with colleagues at the Beth Israel Hospital in Boston , MA , hosted the first demonstration course in valvuloplasty in Boston in 1986 , which followed the live case format that Grüntzig introduced for coronary work . The course featured Alain Cribier , MD , from France ( who championed balloon aortic valvuloplasty ) and also the cardiac valve surgeons and their medical colleagues who had collaborated to perform the first breakthrough surgical valve procedures in the 1950 ’ s . That unique meeting kick-started widespread understanding that there had to be collaboration between surgeons , imagers , and interventionalists in order to best care for patients with valve disease . Now , 30 years later , we have “ Heart Teams ” that oversee structural heart disease intervention . It has been quite a journey .
For you , what are the key issues facing interventional cardiologists today ? If I had to pick two words , they would be “ justification ” and “ quality .” It is not news that all of us in interventional cardiology have been under the microscope for the past years . We are “ low-hanging fruit ,” and the volume of our work impacts the cost of health care . The field of interventional cardiology has expanded so quickly that oversight bodies , such as Cardiology Medicaid Services and , ultimately , the Office of the Inspector General , are now focused on us all .
The issue of appropriateness in interventions constantly reminds us that we need to be as certain as we can that what we do is not only appropriate , but also reflects quality care . Though sometimes it appears onerous , taking the extra time to evaluate an intervention more closely ( think fractional flow reserve or Intravascular ultrasound for coronary interventions ) goes a long way to justify actually doing something . That also becomes a “ quality ” metric . When I look at interventional clinical trials I am struck by how many are simply asking questions of appropriateness of procedures for certain subsets of patients . The currently enrolling COAPT Trial in the U . S . is a good example of interrogating appropriateness . The trial ’ s results , hopefully , will answer the question : “ Should we or should we not try to improve mitral regurgitation in patients with functional mitral regurgitation by doing a transcatheter intervention with the MitraClip ®?” We know we can reduce mitral regurgitation in many patients , but does that equate to improved clinical outcomes ? We will see . That is just one example . I am certain that oversight of what we do will increase . Reimbursements are increasingly being attached to quality metrics , even in our subspecialty . Our challenge is to help make the metrics that are chosen to judge us relevant as well as user friendly to us and to our patients and their outcomes .
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