Chronic Total Occlusion Percutaneous Coronary Intervention: Mindset, Culture, and Continuous Improvement

The development of complex and higher-risk indicated procedures (CHIP) and chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has brought new challenges in terms of operator training. Although the technical aspects of learning CHIP/CTO PCI have been described in detail, very little has been discussed concerning the mental skills that the operator must possess or develop to be successful. Moreover, an at least equally important aspect of CHIP/CTO PCI program development is the professional culture of the institution where these complex procedures are performed, because this can mark the difference between a thriving and long-lasting program and one that is quickly bound to fail. This article analyzes the mental attributes of the CHIP/CTO PCI operator and outlines several leadership principles that can be applied to foster a growth culture and develop a thriving program.