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PCI in the footsteps of Grüntzig

ESC Congress News 2015 - London

BERNHARD MEIER, who delivers the Andreas Grüntzig lecture today, has the distinction of being one of the few people present in the room when Grüntzig himself performed the first ever percutaneous transluminal coronary angioplasty in September 1977.

Cardiovascular Surgery
Interventional Cardiology and Cardiovascular Surgery

Bernhard Meier: ‘The thing I learned from Andreas was to do things as simply as possible.’‘I wouldn’t have ever considered becoming an invasive cardiologist without the influence of Andreas, which makes giving this lecture quite an emotional experience,’ says Meier, now head of Cardiology at University Hospital Bern. Indeed, Meier, then a resident at University Hospital Zurich, played the vital role of sourcing the patient for Grüntzig’s historic coronary angioplasty procedure.

Recalling the ringside seat he had watching Grüntzig’s technical progress, Meier remembers how his mentor got ahead of the game by recruiting a plastics expert to develop form-constant PVC balloons allowing correspondence between balloon size and pressure. ‘Andreas had a contagious energy, but behind his charm was a steely determination that got things done,’ recalls Meier, who in 1981 followed his mentor to work at Emory University in Atlanta.

Returning to Switzerland in 1983, Meier’s noteworthy achievements include launching the renowned Geneva course that trained thousands of European interventional cardiologists in PCI, performing the first balloon valvuloplasty in a human with the Trefoil technique (that does not block blood flow), and being the first to use the Amplatzer device to close the patent foramen ovale (PFO) and left atrial appendage.

Working with Grüntzig, who died in a plane crash in 1985, undoubtedly influenced Meier’s ‘frugal’ approach to PCI. ‘The thing I learnt from Andreas was to do things as simply as possible,’ he says. ‘Inflating a balloon inside the coronary artery is far simpler than performing CABG. What I’ve made my specialty is to strip procedures back to basics. Here you walk a delicate tight-rope because, if you cut corners, you can cause complications just as much as doing too much additional stuff.’

In today’s lecture, ‘Interventional cardiology where real life and science do not necessarily meet’, Meier will outline his frugal philosophy and argue that current insistence on randomised controlled trials can sometimes represents a step too far. ‘Often there’s already enough science,’ he says, ‘and people need to be able to use common sense to extrapolate. In reality you cannot do a randomised trial for every single extension of a procedure.’

Meier cites the case of TAVI, now routinely performed for inoperable elderly patients, which fundamentalists still believe requires a randomised trial before use in younger healthier subjects. ‘To my mind it’s analogous to using a pair of hiking boots to climb Everest and then insisting you perform a trial before you walk up a hill in them,’ he explains.

Another example, he says, is PFO closure in patients who have suffered strokes. ‘In secondary prevention, randomised trials have failed to show a statistical benefit for PFO closure over anticoagulation, since secondary strokes take 10 to 20 years to occur. To me it’s a complete no brainer that you’d choose a simple day case procedure with practically no complications over taking anticoagulants with a major risk of bleed for the rest of your life.’

Andreas Grüntzig Lecture on Interventional Cardiology  30 Aug  8:30-9:10, Regents Park - The Hub