Every fall for the past dozen years, Washington DC has hosted the annual celebration of cardiovascular medical device innovation, inspiration, teaching, marketing, controversy, and edutainment known as TCT. During this week, leading physicians, industry brass, deal makers, and investors mix at scientific sessions, banquet rooms, expo halls, bars, and restaurants at the heart of the heart business. Every year, it seems, has at least a few memorably controversial moments.
My first TCT was not in Washington, but in Milano, Italia. The year was 1997, and I was at the cath lab of legendary innovator Antonio Colombo, along with a host of other industry folks, all hoping that this diminutive giant of interventionl cardiology would honor us by using our particular widget during a live case transmission. Alas, the unremarkable Mini Crown stent that I brought never did make it to prime time. He did, however, open the first live transmission of the conference by performing balloon angioplasty and stenting on a opera singer — while the patient belted out ‘O Sole Mio on the table(!). This was my introduction to the Theater of TCT. Some years later, Colombo opened the conference by implanting perhaps a dozen drug eluting stents in one patient’s coronary arteries. In the opening live case of 2004, a percutaneous aortic valve procedure tragically devolved into urgent practice of CPR and defibrillator techniques. 2001 was one of the few years that I missed TCT; the conference was cut short on its second day by the events of September 11th. This year, for the first time ever, TCT left its home in DC, and came to my own back yard: The Moscone Center in San Francisco.
In recent years, the opening cases have been less flamboyantly Italian, and more conservatively Dutch or German. 2009 was no exception, but it was a highlight none the less. In the opening case from Seiburg, Germany, a CoreValve was successfully placed in a 92 year old patient with aortic stenosis. Recently purchased by Medtronic, the CoreValve device prominently features a Nitinol frame — marking the first of many moments where Nitinol took center stage in Cardiology at TCT 2009. While Nitinol has been a headliner in peripheral vascular stenting, carotid stenting, vena cava filters, and guidewires for many years, this marked the first year where this unique material took center stage in matters of the heart.
Nitinol featured prominently in Wednesday’s Coronary Stent Design and Device Development session, which was so interesting that it prompted evacuation of the Moscone Center for an hour. Noted author Tom Duerig highlighted the unique properties of Nitinol in his Metals as Implantable Materials talk, followed by some spectacular data presented by Juan Granada demonstrating the performance of Prescient Medical‘s vProtect Luminal Shield, a Nitinol stent designed to stabilize vulnerable coronary lesions. The hits kept coming on Thursday, with over three hours dedicated to The Re-Emergence of Self-Expanding Coronary Stents, which included my contribution (on behalf of “Real Metallurgist” Alan Pelton), Important Stent Design and Delivery System Issues Make All the Difference for Coronary Stents. I joined an all-star cast including Renu Virmani, Barry Katzen, Rob Schwartz, and Stefan Verheye along with friends and fellow JJIS alumni Bob Burgermeister and Hikmat Hojeibane, all singing the praises of Nitinol as a solution for persistent challenges in coronary arterial disease. On this year that the center of the cardiovascular universe came to my home turf, Nitinol and NDC were stars at the heart of TCT Theater.