PTCA pioneer passes away: Dr Geoffrey Hartzler dead at age 65

March 13, 2012

Kansas City, MO (update d ) - Dr Geoffrey Hartzler, one of the pioneers of interventional cardiology, passed away on March 10, 2012 following a battle with cancer. He was 65 years old.

Dr Geoffrey Hartzler

[Source: Mid America Heart Institute, 2005]

An interventional cardiologist who began practice in 1974 and who performed the first coronary angioplasty at the Mayo Clinic in 1979, Hartzler was doing successful percutaneous transluminal coronary angioplasty (PTCA) just two years after Dr Andreas Gruentzig performed the first procedure on a patient in Switzerland. Hartzler joined the Mid America Heart Institute in Kansas City, MO in 1980, where he started the angioplasty program, one of the busiest programs in the country, and worked there until he retired in 1995 at 49 years of age due to chronic back pain.

To heartwire , Dr Gregg Stone (Columbia University, New York), who completed an advanced coronary angioplasty fellowship with Hartzler in Kansas City, MO, a fellowship he established in 1986 to train two interventional cardiologists per year, said that his contributions to medicine cannot be overstated.

"Whereas Andreas Gruentzig was responsible for bringing angioplasty to the world, Geoff Hartzler was the single person most responsible for extending its application to the millions of patients who currently benefit each year from interventional cardiology," Stone commented to heart wire . "Whereas Andreas believed PTCA should be restricted to proximal focal lesions, Geoff was the pioneer who brought interventional cardiology (balloons only, no less) to patients with acute MI, multivessel and left main disease, chronic total occlusions, and much more."

Dr Paul Teirstein (Scripps Clinic, La Jolla, CA) told heart wire that despite Hartzler's amazing technical skills, his most profound contribution to cardiology will be his teaching.

"Hundreds visited his cath lab in Kansas City and stood behind him, picking up pearls," said Teirstein. "But for me and a small group of very lucky young physicians, Geoff was our personal mentor. We stood next to him for a year, side by side, learning every nuance of Geoff's skilled maneuvers and his wisdom.  I'll never forget the first thing he said to me on my first day.  Angioplasty is easy, he said, 'I could teach a monkey how to do it . . . and in fact, that's just what I am about to do.' "

A fearless innovator

Hartzler was fearless, added Stone, possessing "technical gifts that to this date have not been equaled," but his career was guided by his compassion for the patient. Along with colleagues at Mid America Heart Institute, Hartzler established a database of interventional cases, and this helped bring evidence-based medicine to the field, said Stone. Live case demonstrations led by Hartzler also helped a generation of doctors become interventional cardiologists.

Dr William O'Neill (University of Miami Health System, FL) told heart wire that he attended an ACC session in 1983 where Hartzler, "this brash, young cowboy," presented his experiences with 250 multivessel PTCAs. Although the audience was incredulous, O'Neill looked Hartzler up and spent three weeks with him as he learned to do coronary angioplasty.

"We developed a bond of friendship that has lasted 30 years," said O'Neill. "He was always full of life and a pioneer in every sense of the word. I never met a doctor more committed to his patients and their welfare. I have never seen another operator with the skill and eye-hand coordination he had. He was a mentor and a friend and will be truly missed."

I think now that he's probably responsible for saving millions of lives around the world.

Speaking with heart wire , Dr Barry Rutherford, the director of interventional research at St Luke's Mid America Heart Institute, called Hartzler's passing a tremendous loss for the cardiology community. He agreed with Stone, saying Hartzler's greatest contribution to interventional cardiology might have been in the acute-MI setting.

"Prior to Geoff, we were all just using streptokinase and waiting for the artery to open," said Rutherford. "Geoff came upon the idea that we could just simply deliver the balloon across the occluded vessel and it would open up. That was so dramatic to see. The patient comes in with an evolving infarct, in a lot of pain, with blood pressure down, and then you open the artery up and suddenly the pain went away and hemodynamics stabilized. He took a lot of criticism over many, many years for that procedure, and we had to defend it at the ACC and AHA, and it probably took 10 years for it to be recognized as the standard of treatment. I think now that he's probably responsible for saving millions of lives around the world."

Dr David Holmes (Mayo Clinic, Rochester, MN) and Hartzler both arrived at the Mayo Clinic together as student clerks in their senior year of medical school. They were assigned to the ECG laboratory together and eventually joined the staff together, working in electrophysiology and also in interventional cardiology.

"He was a brilliant electrophysiologist," Holmes told heart wire . "We think in terms of him being that interventional cardiologist of note, but he was incredibly gifted as an electrophysiologist, doing the first, as far as I know, ablation for ventricular tachycardia."

Teacher to a generation

In addition, Holmes said that Hartzler pioneered advanced pacing and mapping of cardiac arrhythmias and performed work and research that was seminal in the growth of the field. He was always interested in new approaches to treatment, and this interest presaged his groundbreaking work in interventional cardiology.

"In all of these things, his work, his approach, and his life could be summarized by passion, by creativity, by sharing, by educating, and by taking care of patients," said Holmes.

In addition to starting the fellowship program, Hartzler began teaching sessions at Mid America, small sessions that initially had 20 to 30 physicians. These sessions were eventually expanded to include 300 to 400 physicians each year, and in these sessions an entire generation of interventional cardiologists learned their craft.

"I still often hear his voice in my ear, coaching me," added Teirstein. "At a time when angioplasty was thought of as somewhat mysterious, when arteries would suddenly 'go down,' he taught us things didn't just happen. There was a reason for everything, and we just had to figure it out. His thoughtful approach to revascularization and his specialized hand maneuvers are still the backbone of our technique. We teach the Hartzler way to our students, often mentioning his name. Our students continue to pass it down to their colleagues and their students. Through his teachings, Geoff Hartzler will continue to affect the lives of thousands and thousands of patients. In this way, he will always remain with us."

Despite retirement, Hartzler stayed active in business, serving as a consultant or as a director on a number of companies, including serving as the board chair of IntraLuminal Therapeutics, a company he cofounded, from 1997 to 2004.

In a 2005 feature story on some of the occupational hazards of working in the cath lab, Hartzler detailed some of his back problems, including ruptured vertebrae that led to five lumbar laminectomies and a cervical fusion, related to treating so many patients. At the time, he was nearly a decade removed from the cath lab but said he had no regrets about leaving.

"I retired pretty much at the top of my game," Hartzler told heart wire at the time. "I wanted to stop when I was still appreciated for doing good work. People may have a hard time understanding that when I started, interventional cardiology was just coming into being, and I was honored to be part of developing it."

Funeral arrangements for Hartzler have not yet been finalized, but a memorial has been set up at Dignity Memorial. Hartzler is survived by his wife, Dottie, and their four daughters.



Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: