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Alain Cribier and Bernard Gersh honoured at yesterday’s Inaugural Session: They both spoke to ESC Congress News about their distinguished careers and about new developments in cardiology.
This year’s two ESC Gold Medallists pictured after their awards at yesterday’s Inaugural Session. Alain Cribier, left, and Bernard Gersh.
Alain Cribier: As a medical student I trained in well known departments of cardiology and cardiac surgery in Paris and decided cardiology was a fast developing specialty. After some hesitation I finally opted for cardiology over cardiac surgery.
Bernard Gersh: Cardiovascular physiology was the subject I found most interesting as a medical student at the University of Cape Town. The apparent simplicity of the pump, arteries and electrical system seemed far more tangible than abstract subjects like biochemistry.
AC: Albert Scheitzer, who strengthened my teenage conviction to be a doctor; Charles Dubost, a world famous pioneer in cardiac surgery; later in Los Angeles Jeremy Swan and William Ganz, who opened my eyes to research and innovation; finally, Brice Letac, the director of the department of cardiology in Rouen, who pushed me towards research.
BG: Velva Schrire, who established the cardiac clinic at the University of Cape Town, first communicated to me the excitement of clinical cardiology. Cedric Prys-Roberts, my DPhil supervisor at Oxford, taught me about experimental design and how to present, write and analyse data. And from the time I started at the Mayo Clinic, Robert L Frye has taught me a great deal about both medicine and life.
AC: My first experience with cardiac catheterisation in Paris in 1972 encouraged me to take up invasive cardiology. My interest in developing innovative technologies started 30 years ago. Some ideas failed, others were successful, but the resounding success of transcatheter aortic valve implantation allows me to draw up a positive balance sheet overall.
BG: Many areas of cardiology have truly fascinated me, although staying abreast of all these disciplines has sometimes felt like trying to ride four horses at the same time. Natural curiosity has been responsible for my wandering off into all sorts of different areas. The reperfusion era in MI was an absolute highlight from both the clinical and research perspectives, and I have had long standing interests in atrial fibrillation, clinical electrophysiology, hypertrophic cardiomyopathy, outcomes of surgery versus medical therapy in stable CAD, and more recently stem cells and issues related to CVD in the developing world.
AC: Having been able to develop several interventional technologies, and doing so against a background of negative opinions from experts. My three innovations in the field of valve disease, balloon aortic valvuloplasty in 1985, mitral mechanical commissurotomy in 1992, and TAVI in 2002 are my main contributions.
BG: I published a series of papers suggesting AF is not just a rhythm disturbance but the consequence of an interplay of risk factors for vascular disease. I was also involved in the pivotal trial of primary PCI versus thrombolysis and played a role in defining the natural history of HCM. I’ve always been an advocate of evidence-based medicine, and believe evidence should come from analysing your own experience as well as that of others.
AC: Undoubtedly convincing experts of the benefits of TAVI. The project, which involved using transcatheter techniques to implant a percutaneous heart valve within the diseased calcified native valve in the beating heart with no general anaesthesia, was dismissed by many as the ‘most stupid’ idea ever conceived. Who would believe that 14 years after the first-in-man case was performed in Rouen in 2002, 300,000 patients worldwide have been treated with TAVI.
BG: To go from a clinically orientated medical school in South Africa to the academic environment of Oxford University.
AC: The development of interventional cardiology for treatment of coronary artery disease, with angioplasty introduced by Andreas Gruentzig in 1977 the landmark event, followed by a number of exciting related catheter interventions, including coronary stenting. Since the early 1980s, the increasing role of interventional cardiology for treatment of congenital and acquired valvular disease, including TAVI, has considerably enlarged the field of transcatheter interventions and catalysed development of other technologies for structural heart diseases.
BG: The phenomenal declines in CVD mortality attributed to identification of risk factors, angioplasty and the implementation of prevention guidelines by national societies.
AC: I predict the expansion of indications for TAVI to lower risk and younger patients as demonstrated by recent positive results in trials. It’s likely that surgical valve replacement will only be used in patients who are not optimal candidates for TAVI.
BG: The epidemics of diabetes, hypertension and other risk factors pose huge challenges both in the western and developing world. Looking to the future, we need to attack the consequences of our prosperous life styles aggressively through risk factor modifications, which will require massive education programmes and the political will to enact environmental and legislative change.
AC: My role in innovation is behind me. Instead, I am now interested in educational programmes.
BG: To continue the areas of research I have had for the last 30 years, and spend time helping to get CVD research programmes organised in my old alma mater and other institutions in South Africa.
AC: I’d quote André Gide: ‘One doesn’t discover new lands without consenting to lose sight of the shore for a very long time.’ In other words, believe in yourself and never be discouraged.
BG: If you have the drive and intellectual ability to combine clinical work, education and research, this is an incredibly stimulating career and lifestyle opportunity, albeit a busy one. My advice is, don’t worry about change because it will inevitably happen and you will adapt to it.
AC: I have been a Fellow of the ESC for 30 years attending each congress - as invited faculty in most of them - and I gave the 2010 Andreas Gruentzig Lecture in Stockholm.
BG: I am one of the deputy editors of the European Heart Journal, have been on the ESC Guideline Committee on Unstable Angina, and gave the Rene Laennec Lecture in 2010.
AC: Receiving this prestigious award is a privilege and great honour. It’s gratifying to be recognised for my efforts in developing new medical technologies.
BG: I’m really thrilled by this totally unexpected honour. It’s a highlight of my career. Awarding the ESC Gold Medal to non-Europeans emphasises the worldwide fraternity of academic cardiology.
Click here to read other scientific highlights in the full edition of the Congress news.
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