追求卓越 永不止步——Dr. Martin Leon采访

Never Stop in Pursuit of Excellence
——interview with Dr. Martin Leon

    介入心脏病学近些年的进展

    介入心脏病学发展 30年，从单一的球囊成形术，到平台技术包括 1990年问世的裸金属支架，再到生物技术平台，通过器械（支架）和药物来预防再狭窄的生物学进程。在这种转变的过程中，我们在多个领域取得了进展，我们增强了循证医学和临床研究，我们现在能够发现问题并创造生物技术解决方案，并对患者的治疗产生了重要影响。

    尤其是，对于冠心病患者，最令人关注的是药物洗脱支架对于以往接受外科和非确定性治疗的疾病具有确切的疗效。这当然给人以成就感。我们认为，未来通过研发新型支架设计、生物可降解支架及其他改善治疗安全性的方法，可以进一步提高我们的水平。

    经皮瓣膜置换术领域的进展

    我们已经能够成功地治疗冠心病患者，固然，仍有需要进一步提高的地方，例如左主干疾病和慢性完全闭塞病变。在这一点上，有许多围绕介入心脏病学模式的完全崭新领域。

    未来十年一个特别重要的领域是结构性心脏病，这些患者没有血管内或血管疾病，但是有其他类型的心脏病症，可以通过微创导管方式来治疗。例如，成人先天性疾病患者进行卵圆孔未闭手术或者左心耳封闭。

    最突出的是，这意味着治疗瓣膜疾病患者，这些患者以前大部分采用药物治疗（往往无效）或者外科治疗。所以，现在诞生了一个崭新的领域，发展迅速。据预测，治疗瓣膜疾病患者——主要是主动脉瓣和二尖瓣疾病患者——从发展的角度来看，与冠心病的前途是一样广阔的。

    令人兴奋的是，今年的 TCT上我们将看到大量的临床试验数据公布，这些试验显示主动脉和二尖瓣疾病治疗的安全性和有效性以及技术的发展，我们可能看到若干项临床试验结果的首次公布，必会帮助我们更好地理解导管术在治疗瓣膜疾病患者中的作用。所以， TCT应该成为庆祝进入这一领域的旗帜！
 
    TCT的未来

    当我遥望未来，我常想 TCT对于医学教育能做出什么贡献？对于我们这些教育者来说，什么是最重要的？首先是 TCT的核心——永远尊重患者、致力于临床研究、改善心血管病患者治疗。我们将会永远将这个核心放在最重要的位置上。

    但是，为了达到这个目的，需要做很多事。我们要关注医学创新，探索新的治疗方法以最终改善患者的治疗。我们要集中于临床试验的过程，我们称它为“循证医学”，试着去评价那些能影响监管批准和器械上市的新治疗方式。我们要专注于教育过程本身，也就是说，我们如何教育医生？网络教育是否越来越多？我们是否要采用多种教育工具来帮助医生们更加熟悉数据和治疗方式，以应用到自己的临床实践中？最后，教育是否仅是一次现象—— TCT每年秋天召开的 4或5天的会议？或者，我们是否可以发展一种持续性而不是孤立的教育，不断地为医学教育做贡献？

    CCheart:  What are the key breakthroughs in interventional cardiology that have been made in recent years?

    Dr. Martin Leon:  Interventional cardiovascular medicine over more than 3 decades has evolved from a single procedure, which was balloon angioplasty, into a platform technology involving the use of bare-metal stents in the 1990s and even further into a biotechnology platform that now incorporates both the mechanical device (the stent) and pharmacologic agents to prevent the biologic process of restenosis. In making that transition, we have evolved in many different directions. We’ve improved evidence-based medicine and clinical research, and we’re now able to identify problems and create biotechnology solutions so that patient care has been remarkably impacted.

    In particular, as we speak about patients with coronary disease, we have for the most part with drug-eluting stents provided a definitive response to a condition that had previously received   surgical and non-definitive treatment. That certainly is very fulfilling. We think we will reach an even higher level in the future with further innovative stent designs, bioabsorbable stents, and other ways to improve the safety of that treatment process.

    CCheart:  What progress has been made in the field of percutaneous aortic valve replacement? Would you like to share your experience in this area?

    Dr. Martin Leon:  We’ve now successfully addressed patients with coronary disease. Admittedly there are areas we’ll need to refine in the future, such as left main disease and chronic total occlusions, but those are less substantive, iterative adjustments. At this point, there are whole new fields being created around the model of  interventional cardiovascular medicine.

    An area of particular interest over the next decade is structural heart disease, which basically looks at patients who don’t have endovascular or vascular disease but rather have other kinds of cardiovascular syndromes that can be treated creatively with lesser invasive catheter-based modalities. For example, this would include patients with adult congenital disease who undergo a patent foramen ovale closure or left atrial appendage closure.

    Most prominently, this means treating patients with valvular heart disease. That sector has previously been relegated largely to either medical treatment, which is largely ineffective, or surgical therapy. So now there’s a whole new field that is burgeoning. Managing patients with valvular heart disease—principally aortic or mitral valve disease—is predicted to be, from a growth standpoint, as large as what we’re seeing in terms of coronary artery disease.

    What’s exciting for us at TCT this year is that we’re going to see an explosion of new clinical data that speaks to the effectiveness and safety, and the technical development, in these areas of aortic and mitral valve disease treatment. We might see some first-time clinical trial results that will certainly help us better understand the role that catheter treatment is going to play in treating patients with valvular heart disease. So it should be a banner TCT from the standpoint of celebrating the entry of this new field of structural heart disease.

    CCheart:  What will be the future direction of TCT?

    Dr. Martin Leon:  When I think of the future, I think about what contributions TCT can make to the medical education process and what is most important to us as educators.

    The first thing is that the central core of TCT always be a respect for the patient and a dedication to clinical research that can improve treatment of  patients with cardiovascular disease. We will always place that at the highest level of importance.

    But in order to achieve that, many things have to occur. We have to focus on medical innovation, developing new therapies that are ultimately going to provide improvements in patient care. We have to focus on the clinical research process, whereby we use what we call “evidence-based medicine” to try to evaluate these new therapies that will impact the regulatory approval and availability of these new devices. And finally, we have to focus on the educational process itself. Which is to say, how do we educate physicians? Is it going to be more internet-based teaching? Or are we going to employ various educational vehicles that will help physicians become more familiar with the data and treatment modalities so that they can apply them in clinical practice? And finally, is education just a one-time phenomenon: TCT for 4 or 5 days in the fall each year? Or is there a continuing process of education that we can develop to not just be a solitary event but an ongoing commitment to medical education?