The Society of Clinical Perfusion Scientists of Great Britain and Ireland and The College of Clinical Perfusion Scientists of Great Britain and Ireland
September/October 2012

September/October 2012

Richard Mason

The invited guest speaker at this year’s Congress in Reading will be Dr Mike Norell, who is a consultant cardiologist at New Cross Hospital in Wolverhampton. Dr Norell will be revisiting the subject of the relative merits of coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) (as a cardiologist he would almost certainly be inclined to put those the other way round!).

Sifting through the evidence and attempting to identify definitive arguments for and against these two modes of treatment has traditionally been anything other than straightforward, not least because, quite naturally some might say, we will have tended to find ourselves presented with data that is weighted in varying ways, depending on whether the investigators are surgeons or physicians. Notwithstanding this, now that we have had the opportunity to digest the findings of the SYNTAX trial it has become increasingly difficult for us to accept that the proponents of PCI have a valid point if they choose to suggest that this route is superior to the CABG option in patients with multivessel disease as far as survival rates and the need for repeat revascularisation are concerned.

If the results of SYNTAX for this group of patients are to be believed, it raises the question of why PCI continues to be offered to and accepted by so many of the very patients for whom the statistical evidence may indicate that surgery offers a more favourable option. Many explanations for this have been put forward, particularly in the area of informed (or uninformed) patient consent, and we look forward to hearing Dr Norell’s take on this. As many of you will know, one of my surgical colleagues here in Oxford is Professor David Taggart, and if you are familiar with any part of the large body of work that he has produced on this subject, I am sure that you will not need me to point out that his views on this issue are likely to diverge markedly from those of Dr Norell!

While the debate on the claims of surgery and PCI rages on, if we cast our minds back to the days when balloon angioplasty was in its infancy, it is startling to see how much has changed in the manner that treatment of coronary artery disease has been conducted over the last thirty years. I remember Mike Norell as a cardiology senior registrar at the London Chest Hospital in the mid-1980s, a time when PCI (or the Gruntzig procedure as it was then known) had just started to gain popularity (at least amongst cardiologists!) in the UK. In those days physicians were very much at base camp on their learning curve for this procedure and rarely ventured beyond attempts at treating single vessel disease, which did not prevent emergency cardiopulmonary bypass resuscitation either in the catheter lab or an empty anaesthetic room seeming like an almost weekly occurrence. Contrast that era with today, where multivessel angioplasty is as mainstream as the surgical option, and where, if your unit is similar to mine, you will probably be hard pushed to remember the last time you had a cardiologist poking his head round the theatre door pleading for a bail-out. Even if it is argued that it is questionable for so many of our patients to be offered percutaneous treatment as opposed to surgery, it has to be acknowledged that progress in terms of how the technique has been mastered by a generation of practitioners has been remarkable.

As I have said, I remember Mike Norell from our early days together at the London Chest and can guarantee that his address will be both stimulating and entertaining. I am sure that there will be many areas of this subject on which UK perfusionists, as components of the surgical workforce, will require clarification and this will clearly be the forum for these uncertainties to be cleared up. I am personally looking forward to attempting to get Dr Norell to digress somewhat and enlighten us as to his position on another thorny subject, TAVI versus conventional medical therapy.

See you in Reading.