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Prof. Stephan Achenbach, MD, is the Chairman of the Department of Cardiology at the University Hospital in Erlangen, Germany. Smaller hospitals in the region refer patients there specifically for complex interventional cardiology procedures. At the same time, his department provides routine cardiac care for the city of Erlangen, with a population of 100,000, as well as the surrounding area. The University hospital is home to Erlangen’s only 24/7 emergency service for interventional cardiology. We spoke to Prof. Achenbach about the daily balancing act between routine and advanced interventional procedures. Prof. Achenbach, has the spectrum of interventional cardiology procedures changed in recent years? Of course. Today, we routinely carry out procedures that were simply not possible in the past. This includes transcatheter aortic valve implantation and transcatheter closure of the left atrial appendage to name just a few. Currently, we are even seeing the first catheter-based mitral valve replacements. The spectrum is constantly becoming broader as new techniques and approaches are being developed. However, it is very hard to predict what the mix of basic as compared to very complex procedures will be in typical cardiac catheterization laboratories just a few years from now. Even though you may hear many interventionalists ask “where have all the type A lesions gone?”, routine procedures still clearly dominate the workload – and this is the case for every interventional cardiology program, including my own department. In our country it would not be possible to focus an entire program solely on complex procedures. In many cases they would not even be adequately reimbursed. From your point of view, what constitutes a complex procedure and what is routine intervention? While every intervention that initially seemed “routine” can unpredictably turn into a complex case at any time, I would draw a somewhat arbitrary line at chronic total coronary artery occlusions. Were the situation to arise, would it be preferable to have separate rooms for complicated procedures and routine catheter interventions? Certainly. That would make it easier to manage the caseload of the day. Not every patient who needs a cardiac examination requires a high-end system. Actually, for routine procedures, having to operate a very elaborate system may even be a distracting. For example, when the user is not fully familiar with the angiography system and interaction is not intuitive. Routine procedures are all about working quickly, safely and efficiently. It is patient throughput that counts. On the other hand, in the case of complex procedures, it is important to be able to take the time needed and not to feel under pressure because the next procedure is waiting in line. Cover story Investing in Routine By Hildegard Kaulen, PhD “A good angiography system provides good images; a very good system provides good images at low radiation dose.” Prof. Stephan Achenbach, MD Cardiology Department, University Clinic in Erlangen, Germany 12  AXIOM Innovations | December 2013 | www.siemens.com/angiography


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