Ever safer - ever better

Welcome to my "Paris Blog"

Each spring there is a meeting where some 12,000 cardiologists and others come together to discuss the latest findings in interventional cardiology. The meeting started over 10 years ago to discuss advances in coronary angioplasty. This is the procedure where cardiologists stretch narrowings in the heart arteries using an inflatable balloon. Over the years angioplasty has rapidly developed and we have come to understand the things we need to do to get the best results.

A major development has been the use of stents. These are metal coils that are put into the heart arteries to keep them open after they have been opened with balloons.
One of the major achievemnts of angioplasty has been for some patients to avoid the need for coronary bypass surgery which involves general anaesthesia and
opening the chest.

When angioplasty was first introduced in the late 1970s it was only done in patients considered relatively straightforward. These were usually patients with a single narrowing in the artery supplying the front wall of the heart. As we became more experienced we treated patients with ever more complicated problems.

We now treat patients

• With several narrowings in the heart arteries.
• With narrowings where the procedure is more complicated eg at places where the arteries branch
• With arteries which are completely blocked - we may be able to reopen these
• Patients having a heart attack - an important group where angioplasty has been shown to save lives.

Over the years the quality of the materials we use, particularly the stents and the blood thinning drugs given to heart patients has greatly improved. We also are better at selecting the best type of stent for each individual narrowing. As a result angioplasty has become much safer and routine.

At the most recent meeting in Paris there was much discussion about how to treat patients with some of the most severe coronary disease. These patients have a narrowing of the main left coronary artery. This is a short artery but it gives rise to to large branches - one supplies the front to the heart and the other the side. Traditionally patients with left main coronary disease have been referred for early Coronary Artery Bypass Surgery but with modern techniques some seem to do just as well with angioplasty. It was clear from the discussions that careful review of each individual patient is required by Cardiologists and Heart Surgeons before a decision is made.