Understanding Coronary Interventions (inc TAVI)

Understanding cardiac interventions requires appreciation of the many historical steps that led up to the current practices that we now recognise as commonplace.

Once Forssman (1929) demonstrated that the heart could safely be accessed from the peripheral circulation, it was only a matter of time until radiographic images of the coronary arteries were possible. This allowed the development of coronary artery bypass grafting (CABG; 1967), and percutaneous coronary intervention (PCI; 1977). Acute vessel closure and restenosis, complications of PCI, were addressed with the introduction of metallic stents in 1987. Their tendency to promote build-up of tissue within the stent itself was mitigated with drug-eluting stents in 2002.

The less invasive option of PCI is applied in settings when CABG presents higher risk. Hence it is routinely used in acute coronary syndromes and as default - or “primary” - treatment for acute myocardial infarction. In recent years, percutaneous technology has been applied to aortic stenosis with the use of transcatheter aortic valve implantation (TAVI). This is increasingly used in elderly or comorbid patients who present higher risk for surgery.

Importantly, each stepwise development in the field of cardiac intervention has been tested in randomised trials against the prevailing standard of care.