1980s: Expanding the practice

The 1970s focused on the major function of the catheterization laboratory: obtaining data needed for the accurate anatomic and physiologic assessment of both congenital and acquired cardiovascular disease. The 1980s saw major growth of therapeutic procedures beginning with the rapid implementation of coronary balloon angioplasty. Complications such as acute/threatened closure remained serious issues, but the introduction of stents improved immediate periprocedural results and decreased the need for urgent bypass surgery. Mayo investigators made important observations on the effect of thrombus in patients with unstable angina and myocardial infarction. There was active involvement in strategies of care for acute myocardial infarction-lytic therapy versus angioplasty. Major changes in the catheterization laboratory included recruitment of new physicians and changes in staffing rotations. The decade also saw the development and testing of new devices aimed at making angioplasty procedures more predictable and safer in a variety of lesion and patient subsets. Other areas of interest included the treatment of patients with multivessel coronary artery disease (MVD). Mayo was ideally placed for significant involvement in this-the two people most involved in MVD angioplasty were on the Mayo Clinic staff, and the infrastructure for trial design with established investigators was in place to begin evaluation of angioplasty versus bypass surgery. Other important areas of focus included development of high-definition video systems for routine use, including strategies for reducing radiation exposure while maintaining optimal image quality. Technologic advances using transseptal catheterization for better hemodynamic assessment of structural heart disease were introduced, as were protocols for the evaluation of pulmonary hypertension.