The Current and Future State of Interventional Cardiology: A Critical Appraisal

Abstract

After 75 years of invasive and over 50 years of interventional cardiology, cardiac catheter-based procedures have become the most frequently used interventions of modern medicine. Patients undergoing a percutaneous coronary intervention (PCI) outnumber those with coronary artery bypass surgery by a factor of 2 to 4. The default approach to PCI is the implantation of a (drug-eluting) stent, in spite of the fact that it improves the results of balloon angioplasty only in about 25% of cases. The dominance of stenting over conservative therapy or balloon angioplasty on one hand and bypass surgery on the other hand is a flagrant example of how medical research is digested an applied in real life. Apart from electrophysiological interventions, closure ot the patent foramen ovale and percutaneous replacement of the aortic valve in the elderly have the potential of becoming daily routine procedures in catheterization laboratories around the world. Stem cell regeneration of vessels or heart muscle, on the other hand, may remain a dream never to come true.

Impact of Advances in Invasive Cardiology on Cardiac Surgery

“…Patients undergoing a percutaneous coronary intervention outnumber those with coronary artery bypass surgery by a factor of 2 to 4. The default approach to PCI is the implantation of a drug-eluting stent (DES), in spite of the fact that it improves the results of balloon angioplasty only in about 25% of cases [7, 8] It is interesting to note that Andreas Gruentzig who is considered the father of interventional cardiology started the first technical revolution in 1977 when He introduced balloon percutaneous transluminal coronary angioplasty (PTCA) and envisioned that only around 10 to 15% of patients with coronary artery disease were treatable by angioplasty [9]. The irony is that these figures represent the number of cases that are currently referred to surgery Fig.…”

Eustachian valve, patent foramen ovale and paradoxical embolism

“…This is particularly relevant in view of the current interest in PFO and its role in paradoxical embolism [2][3][4][5][6][7], the successful introduction of percutaneous closure of an interatrial communication [8,9], and the controversy surrounding which PFO should be percutaneously closed [10]. The prevalence of PFO is 20.8% in the general population [11] and 27.3% in the autopsy series [12].…”