Practical Interventional Cardiology: Third Edition
2017 represents an important milestone in Interventional Cardiology as we celebrate both the 40th anniversary of the first percutaneous transluminal coronary angioplasty (PTCA) by Andreas Grϋntzig in Zurich, Switzerland, and the 50th anniversary of the first coronary artery bypass surgery by Rene Favorolo in the USA. The first patient to undergo PTCA was 39-year-old Adolf Bachmann who is alive and well to this day. However, although clinically effective, acceptance of this new technique was by no means immediate. Skepticism and resistance was widespread for many years as PTCA faced a number of problems that required technical improvements and scientific validation.
As I browse through the second edition of Practical Interventional Cardiology, which was published 15 years ago, it is readily apparent that subsequent developments in Interventional Cardiology have been both astonishing and, in some instances, unexpected.
Astonishing, because the combination of new operator skills, superior equipment and new pharmacotherapy has led to a pronounced reduction in procedural risks, which has in turn propelled a truly exponential worldwide growth in percutaneous cardiovascular interventional procedures. The best illustration has to be the development of the intracoronary stent. Since its tentative debut as a rigid, awkward and very expensive item, it has largely overcome its flaws (and rivals) to become the sleek, safe and highly effective device that has taken centre stage and is undeniably one of the linchpins of interventional cardiology. It is easy to forget that coronary intervention before the advent of the stent primarily consisted of balloon angioplasty. This was much riskier and unpredictable than today’s procedures, which nearly always incorporate a stent (referred to as PCI), with surgical standby an absolute necessity, for good reason. Furthermore, the management of acute coronary syndromes (especially ST-segment elevation myocardial infarction) was regarded by many as ‘tiger country,’ where only pharmacotherapy was deemed to be safe despite the lack of efficacy and associated high mortality. Thankfully, those days are gone, and I do sometimes find myself feeling satisfied to have taken part in such an incredible transition in such a short space of time.
Unexpected, because no one foresaw the emergence of some of the new therapeutic interventions. The prime contender has to be the introduction and rapid growth in structural heart intervention, in particular percutaneous aortic valve implantation (TAVI). As initial concerns, such as access-site complications, para-valvular leaks and valve durability continue to be addressed, it is clear that this procedure has much further to go. It is also interesting to observe the variation in approaches currently being used to overcome the complex and difficult problems associated with percutaneous mitral valve intervention.
By highlighting these areas, I am aware that I have omitted many other important aspects and developments. Clearly, a lack of space will not allow me to expand here. However, I have ensured that these are given their rightful importance in this new and comprehensively updated edition. I am sure you will enjoy reading the chapters written by world leaders in their specialised fields.
Although it has been an onerous task to collate this third edition within tight time schedules so that it reflects current knowledge and practice in a rapidly changing field, it has been an immensely rewarding experience. I am very grateful to all the contributors of this book and have been humbled by their knowledge, their generosity and their willingness to participate. I am also thankful to our colleagues in industry for their assistance in providing technical details and data. I deeply appreciate the personal efforts, technical expertise and invaluable assistance of all at Taylor and Francis Group. In particular, I would like to mention Lance Wobus, Jessica Vega, Judith Simon (USA), Gabriel Schenk, Alice Oven, Drew Gwilliams and Ben O’Hara (UK) at Taylor & Francis Group, as well as Ramya Gangadharan (India) at diacriTech.
Ever D. Grech
South Yorkshire Cardiothoracic Centre,
Sheffield, United Kingdom
|October 23, 2017
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