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
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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 Tshirt 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
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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
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CRMH*
Salem VA
Lewis Gayle
Lynchburg
CNRV*
Montgomery Regional
Martinsville
Bluefield Regional*
* HeartNet Hospitals
Carilion Roanoke Memorial
Hospital
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Date cath lab first opened under the direction of:
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First coronary angioplasty:
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1985 Dr. Phillip Shiner and Dr. John Starr
First coronary stent:
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1972 Dr. Phillip Shiner
1991
First rotational atherectomy
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1995
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First pacemaker:
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First ICD:
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First Aflutter Ablation
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1995
1988
Procedural capabilities:
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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:
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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
• 1989
1991
2000
2000
2013
Bath County Community Hospital
Bedford County Memorial Hospital
Bluefield Regional Medical Center
Franklin Memorial Hospital
Giles Memorial Hospital
Radford Community Hospital
Roanoke Memorial Regional Heart Center
Tazewell Community Hospital
Wythe County Community Hospital
Stonewall Jackson Hospital
Pocahontas Memorial Hospital
Princeton Community Hospital
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:
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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:
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Diagnostic cath
PCI
Pacemaker Implantation
ICD Implantation
Danville
• Date cath lab first opened under the direction of:
• First coronary intervention:
• First pacemaker:
• Procedural capabilities:
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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:
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Diagnostic cath
PCI
Pacemaker Implantation
ICD Implantation
Cardiac Catheterizations
Performed in Virgina
Spectrum of Structural Heart
Disease