The pathology of cardiovascular interventions and devices for coronary artery disease, vascular disease, heart failure, and arrhythmias

The last several decades have seen a virtual explosion in the armamentarium of surgical and interventional procedures and their associated medical devices for the management of cardiovascular disease. In virtually all areas, there has been a clear trend from open surgical to minimally invasive to endovascular interventions. The development and widespread use of prosthetic heart valves, discussed in a preceding chapter, was an early major development in the field, and continues to stimulate innovation. Revascularization using percutaneous coronary interventions with stent implantation is now widely performed in patients with coronary artery disease and this has reduced the frequency of coronary artery bypass graft surgery. Aortic and peripheral vascular diseases were first treated with open surgical repairs with vascular grafts and more recently by endovascular procedures using stent-grafts. Mechanical circulatory support maintained with various devices has become a mainstay of the management of advanced heart failure. Devices and procedures for the control of arrhythmias are also of major importance. This chapter will discuss the characteristics of the various interventions and devices, their progression of innovation, and the key pathological considerations related to their use.