Sooner or later, we’ll all know someone who has lost his or her life to heart disease, and today, Sept. 10, 2012, is the 20th anniversary of my father’s passing. George Edward McCarty had undergone a triple bypass several years earlier, but restenosis of the coronary arteries and an otherwise failing heart would be his undoing.
The world of medical technology has changed enormously since Dad died, so much so that what we now take for granted might have seemed miraculous in 1992. Would Dad have lived another 20 years had his predicament arisen 20 years later in medical history? It’s tough to say.
You know, it really is too bad Dad isn’t here to grouse about these things, but don’t worry. I’m happy to take care of that for him. That’s what a loving son does, right?
Stents become standard of care
One of the more pivotal advances in the field of interventional cardiology is the balloon-expandable stent, which first won an FDA approval for coronary arteries in 1994. The inception of the drug-eluting stent in 2003 deserves a mention partly because of late thrombosis. Restenosis was a big problem for some patients with bare-metal stents, though, and the DES has gone a long way to address this problem.
Dad’s first surgery was a bypass, but clearly restenosis was an enormous problem for him. Some sort of anti-proliferative might not have extended his life, but it might have done wonders for the way he lived.
I have no idea whether Dad gave his doctors a hard time, but I’m going to go out on a limb and say a little less restenosis would have given him fewer excuses to give a self-regarding MD a ration of you-know-what (as his son, I’m allowed to say Dad was good at giving people a hard time. Believe me, wherever he is, he knows it’s true).
Is the bioresorbable stent finally about to find its way into the cath lab? Maybe. How might Dad have reacted to the claim that a dissolving stent can prop open an artery that’s capable of sustaining a dozen atmospheres of pressure from an angioplasty balloon?
My guess is he’d say, “I was born in Ohio, but I’m from Missouri where this kind of thing is concerned.” Dad wasn’t always in the best health, but he possessed a healthy skepticism, and that’s putting it mildly.
TAVR finally comes ashore in the U.S.
The subhead “comes ashore in the U.S.” may sound funny, but the Sapien aortic valve for catheter delivery (a.k.a., TAVR) has been available in Europe for nearly half a decade. Edwards managed an FDA approval for the Sapien only in late 2011, and Medtronic is working to snag a PMA for its CoreValve.
I have no idea what kind of shape my dad’s aortic valve was in when he died, but I’m pretty sure he had at least some congestive heart failure, and his aortic valve could not have been in very good shape.
Incidentally, I won’t bother to explain what I think Dad would say about device lag, but I guarantee you one thing: It wouldn’t be pretty. Even I don’t want to know, and I still miss him!
There are so many more developments in the world of interventional cardiology (not to mention electrophysiology), and there are so many conversations I would love to have had with Dad, but the message here is simple. Hats off to dads and devices.
Some people think devices are overused, and one or two crackpot feminists have argued dads are superfluous. Don’t know about you, but I wouldn’t care to live in a world that lacked either of them.