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I was pleased to see the thoughtful editorial by Dr. Chris White (1) in a recent issue of JACC: Cardiovascular Interventions. I remember the case Dr. White describes very well, and it reminded me of the many lessons we have learned about product development over the past 40 years. I also learned from Drs. Simpson and Gruntzig the importance of honesty and integrity in always placing the patient first.
It is not easy when there is an obvious conflict when you as the operator own the technology and have a financial interest in the outcome. That day was the very first Transcatheter Cardiovascular Therapeutics meeting at which I did a live case demonstration, and the case Drs. Leon and Kent picked was a circumflex lesion, easy by today’s standards, but back then I knew it would be a challenge from the start. We considered not even trying, but I thought it might be good for the audience to see me struggle and that this was not an easy procedure, given the limitations of our rigid delivery system. If I failed, perhaps I would have saved future patients from overaggressive operators pushing the technology too far. It was an easy decision to quit when the conditions were not just right.
A few years later, a similar interaction took place in Toulouse, France, where a live case I did with one of the premier operators of all time, Dr. Jean Marco, also did not go nearly so well. Dr. Marco apologized profusely, but I responded that the purpose of live case demonstrations is to teach the good along with the bad. The audience doesn’t learn nearly as much when things go well as they do when they go badly. I didn’t want our colleagues thinking that this was an easy procedure. Live case demonstrations require special discipline to make sure the patient is not harmed, no matter how much pressure there might be to succeed.
So Dr. White is correct in his conclusions about teaching our young fellows these valuable lessons. He has been a driving force in our family of interventional cardiology for many years, and we are all lucky to have him as one of our mentors for young trainees. I will leave him with one of my favorite quotations, which I continue to preach to our fellows: “Of all the manifestations of power, the one that men respect most is restraint.”
Please note: Dr. Schatz has reported that he has no relationships relevant to the contents of this paper to disclose.