1. HeartNet

2. 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

3. Disclosures
I have no relevant financial disclosures.

4. 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.

5. Areas of Evolution 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

6. 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.

7. Timeline 1929 1st cardiac catheterization of a Human
Dr. Werner Forssman, Eberswald Germany
st cardiac ouput
Andre Cournand and Dickins Richards
1953 Seldinger percutantous approach introduction of catheters.
Sven-Ivar. Actaradiol (39) (5):
st open heart operation with bypass
John Gibbon at Thomas Jefferson Hospital Philadelphia

9. Timeline 1958 Selective coronary angiography 1964 Dotter Technique
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

10. Sones and the 11 inch Image Intensifier used for the First Coronary Arteriogram

11. Cine Frame of the First Right Coronary Mason Sones October 30, 1968

12. Cine frame taken by F. Mason Sones, MD, of the first aortocoronary saphenous vein graft inserted by Rene Favaloro, MD.

14. Dr. Mason Sones, at left about 1960, performing early coronary angiography at the Cleveland Clinic. Sones, who was known for wearing a V-neck T-shirt 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

18. Timeline 1973 Gantries with Rotating U arms
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.

20. 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

22. 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

23. Timeline 1997 > 1 million angioplasties worldwide
% of patients with PCI received stent
million angioplasties worldwide

24. 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

25. Structural Approvals 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

26. Helmuth Hertz and Inge Edler The First Echocardiograph

27. Southwestern Virginia Cath Labs
CRMH*
Salem VA
Lewis Gayle
Lynchburg
CNRV*
Montgomery Regional
Martinsville
Bluefield Regional*
* HeartNet Hospitals

28. Carilion Roanoke Memorial Hospital
Date cath lab first opened under the direction of: 
1972 Dr. Phillip Shiner
First coronary angioplasty:   
1985 Dr. Phillip Shiner and Dr. John Starr
First coronary stent:
1991
First rotational atherectomy
1995
First pacemaker:
First ICD:
First Aflutter Ablation
1988
Procedural capabilities:
Diagnostic cath
PCI
Pacemaker Implantation
ICD Implantation
Open Heart Surgery

30. Lewis Gayle Date cath lab first opened under the direction of:
First coronary intervention:   
First pacemaker:
Procedural capabilities:
Diagnostic cath
PCI
Pacemaker Implantation
ICD Implantation
Open Heart Surgery

31. 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

32. Community Hospital Date cath lab first opened under the direction of:
First coronary intervention:   
First pacemaker:
Procedural capabilities:
Diagnostic cath
PCI
Pacemaker Implantation

33. HeartNet of the Virginias Est. 1989
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
1991
Stonewall Jackson Hospital
2000
Pocahontas Memorial Hospital
Princeton Community Hospital
2013
Greenbrier Valley Medical Center

34. Bluefield Regional Medical Center
Date cath lab first opened under the direction of: 
August 1989
First coronary intervention:   
October 2012
First pacemaker:
Procedural capabilities:
Diagnostic cath
PCI
Pacemaker Implantation
ICD Implantation
Open Heart Surgery

35. Date cath lab first opened under the direction of:
1990 Dr. Barnett, Dr. Wyne, Dr. Happell & Dr. Crafford
First coronary intervention:   
March 27, Dr. Shin lee Tan
First pacemaker:
May Dr. Uzair Wyne
First ICD:
July 24, Dr. Jose Rivero
Procedural capabilities:
Diagnostic cath
PCI
Pacemaker Implantation
ICD Implantation

36. Danville Date cath lab first opened under the direction of:
First coronary intervention:   
First pacemaker:
Procedural capabilities:
Diagnostic cath
PCI
Pacemaker Implantation
ICD Implantation
Open Heart Surgery

37. Memorial Hospital Martinsville

38. Martinsville Date cath lab first opened under the direction of :
Jan 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:
Diagnostic cath
PCI
Pacemaker Implantation
ICD Implantation

39. Cardiac Catheterizations Performed in Virgina

40. Spectrum of Structural Heart Disease