Corrado Tamburino (full professor of Cardiology, Ferrarotto & Policlinico Hospitals, University of Catania, Catania, Italy), and a course director for PCR London Valves (20–22 September, Berlin, Germany), has done extensive work in developing percutaneous coronary intervention (PCI) techniques for left main disease and has also been involved in evaluating transcatheter aortic valve implantation (TAVI). He speaks to Cardiovascular News about what he thinks has been the most important developments in interventional cardiology during his career and the potential future of TAVI.
Why did you decide to become a doctor and why in particular, did you decide to become an interventional cardiologist?
I was inspired to become a physician by my grandfather and my father, who were both professors at Catania University (Catania, Italy) and were very esteemed doctors—they both specialised in internal medicine, photophysiology, haematology and cardiology. I was very fascinated by their passion, enthusiasm and dedication to patient care, research and education of medical students. My grandfather’s graduation thesis, in 1910, was on “heart and miocardio kinetics drugs”.
Regarding my choice to specialise in cardiology and in particular, interventional cardiology, circumstances, local demand, scientific and clinical interests, personal attitudes and the potential for professional satisfaction were all factors guiding my decision. Indeed in 1982, when I graduated from the medical school of the University of Catania, among the non-surgical medicine specialties, cardiology offered a specific non-invasive clinical activity that was in demand and an invasive one that was really a “new born” and a “hot topic”—one that had great potential to improve patient care and save lives. Therefore, I was very motivated to go into these areas and, when I started working, I felt becoming the “cath guy” was the right decision. Now I am really happy because I do what I like to do: working as an interventional cardiologist, who has had the opportunity to create a great team and cardiology school with younger, eager, and skilled colleagues.
Who have been your career mentors?
I have not had a specific mentor during my career. My willingness and hard work for several years in cath lab, along with my handy skills, allowed me to gain increasing experience in the field. However, my wife Valentina has been a major influence throughout my career. She is a psychologist and has always encouraged and pushed me but, at the same time, she keeps me grounded and well balanced.
What has been the most important development in interventional cardiology during your career?
Technologies and scientific evidence in the field of interventional cardiology have been rapidly increasing, leading to the extension of percutaneous treatment for more and more complex patients with coronary artery disease or with structural heart disease.
In coronary interventions, the development of safer and more effective stents has been important. As well as these advancements, the building up of data for the best revascularisation strategies, the optimal antithrombotic regimens that balance efficacy against safety, and the role of intravascular imaging for indicating the need for PCI or optimising PCI outcomes have also been important.
In terms of structural heart disease, TAVI has had the most influential and favourable effect on patient care.
Of all the interventions that have been introduced, what has been the biggest disappointment—ie. something that you thought would revolutionise treatment but did not?
I have been disappointed by the data for renal denervation, which failed to demonstrate the hypothesised efficacy of the intervention. However, the studies have several limitations and the lack of efficacy with renal denervation was probably because of inappropriate technique and patient selection. Thus, the negative evidence has only raised some doubts, which are the beginning of wisdom. Doubts lead to suggestions as to where improvements are needed. I believe further better-designed studies may provide insights into the selective efficacy of this promising technology.
Of the research you have been involved with, what do you think has had the biggest clinical impact?
For the last 10 years, my team and I have been pioneering several innovative coronary and structural interventions. This has allowed us to be involved in several large registries providing important data, which have contributed to the improvements and implementation of relevant procedures.
You have done extensive work in the management of PCI for left main disease. When would you use PCI for patients with this condition?
Certainly, I would use PCI for the treatment of left main in patients at high surgical risk. In patients with left main disease at low surgical risk, I would consider PCI rather than surgery if a patient did not have concomitant extensive multivessel disease outside the left main. In this regard, I have been involved in works on risk stratification and decision-making in patients with left main disease.
What are the key tips for achieving optimum results with PCI in these patients?
It is important to plan the stenting strategy by considering all relevant factors, which include plaque distribution, left main size, disease extent in the side branch, bifurcation angles, functional importance of branches, and clinical presentation. Furthermore, a more liberal use of intravascular imaging is helpful for PCI optimisation. Finally, it is of relevance to master all technical advices for an optimal bifurcation technique.
You have also done substantial work with TAVI. Do you think we will ever reach the stage at which TAVI becomes the preferred option for all patients with aortic stenosis?
Recent data for the long-term follow up after TAVI have demonstrated durable efficacy and safety outcomes with the intervention, setting the foundations for its extended use in patients at intermediate risk. I have recently chaired a large registry (OBSERVANT) that matched immediate-risk patients undergoing TAVI with those undergoing surgical replacement, which showed favourable results for TAVI at three years. A recently published, small randomised study (NOTION) also evaluated TAVI in intermediate-risk patients and had similar results to OBSERVANT. Therefore, while awaiting the results of large ongoing trials, these preliminary, but important, data suggest that TAVI might perform well also in patients at lower risk. Personally, I predict TAVI will become the preferred option in the future regardless of patient’s surgical risk—especially with the introduction of new TAVI prostheses.
What are your current research interests?
Currently, my research interests are mostly focusing on bioresorbable scaffolds, on all percutaneous treatments of aortic and mitral valve disease, and on invasive strategies for heart failure.
You are one of the course directors of PCR London Valves. What were the main themes of this year?
After the first imaging day, there were four main paths dedicated to all the cardiac valves, with a special focus on strategies to reproduce the established TAVI approach and experience to the mitral valve treatment.
How do we transfer what we have learned with TAVI to percutaneous approaches for the mitral valve?
It is a complex discussion, because aortic and mitral valves are two completely different apparatuses. However, the methodological approach, the use of the heart team, and the development of algorithms for appropriate device and patient selection that have driven the success of TAVI will also beimportant for establishing percutaneous treatments for mitral valve disease. Of course technology refinements will also help to develop transcatheter treatments. However, the mitral valve has more complex anatomy than the aortic valve, so repeating the success of TAVI with transcatheter approaches for the mitral valve is a huge challenge.
You are also on the faculty of Transcatheter Cardiovascular Therapeutics (TCT; 12–16 October, San Francisco, USA). What are the key differences between European and American conferences?
Both American and European conferences provide cutting-edge educational content for continuing medical education of physicians, to improve patients’ care. European conferences include more pragmatic and interactive sessions. On the other hand, American conferences provide more late-breaking science combined with practical learning.
What advice would you give to someone just starting their career in interventional cardiology?
Firstly I would suggest participating in key general fellow courses, or in dedicated meetings—such as those focusing on complications managements or on intravascular imaging. Additionally, it is important to obtain good knowledge on the intervention material and on techniques minimising radiation exposure. Also, I would suggest doing a fellowship abroad in an experienced and advanced centre.
Outside of medicine, what are your key interests?
I live in an old family house with a large garden where I spend amazing times with my family, and I exercise and do gardening. A few times a year, I love to go to my house in Engadina, Switzerland, where I relax by skiing, biking and trekking. I do enjoy reading adventure novels, but my new hobbies are painting and drawing, with a special focus on nature landscapes. But, one of my favourite hobbies—though I do not have the time to do so—is to do nothing and daydream!
Appointments
Full professor of Cardiology; head of Cardiology Division and Cardio-Thoracic &Vascular
Department; director of Postgraduate School of Cardiology, Ferrarotto & Policlinico Hospitals, University of Catania, Catania, Italy
Education
1991 – Postgraduate school, cardiology, University of Catania, Catania, Italy
1988 – PhD in Internal Medicine, University of Catania, Catania, Italy
1982 – Degree in Medicine and Surgery, graduated with the grade 110/100 with distinction, University of Catania, Catania, Italy
Societies
- Co-course director, PCR London Valves
- Faculty, TCT
Fellowships
- Member of Italian Society of Internal Medicine
- Fellow of Italian Society of Cardiology
- Fellow of Italian Society of Angiology
- Fellow of European Society of Cardiology
- Fellow of Italian Society of Invasive Cardiology
Principal investigator
- ABSORB (Bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions)
- ACCOAST (Pretreatment with Prasugrel in non–ST-segment elevation acute coronary syndromes)
- CYPHER
- PEGASUS _TIMI54 (Long-term use of ticagrelor in patients with prior myocardial infarction)
- WIN TAVI (Women’s international transcatheter aortic valve implantation) registry
