Pioneering Techniques for Better Cardiac Treatment

Could you talk to me about your journey in healthcare and the current role and responsibilities at Mount Sinai?

I am a cardiac surgeon focused on structural heart disease; I have been in the surgical space for more than 10 years ago now. I was fortunate enough to train on transcatheter aortic valve replacement (TAVR) and transcatheter aortic valve implantation (TAVI) in Europe and Canada when it first became a viable option for structural heart procedures.

Since then, the field has taken off and the technology has also improved, with TAVI procedures now approved in all patients regardless of surgical risk with symptomatic aortic stenosis.

What according to you are some of the major challenges that have been impacting the medical space?

Today, percutaneous cardiac valvular replacement procedures have expanded beyond the aortic valve to include techniques for the mitral and tricuspid valves as well. There are now non-surgical options to treat mitral and tricuspid valve disease and I am fortunate enough to be at the forefront of this, leading multiple clinical trials.

Now, to answer your question about the challenges, I would say there are three sets of challenges. One, how to frame devices to patients’ bedside safely and effectively? Two, how to leverage the current limited resources to perform these procedures while simultaneously enrolling patients into relevant clinical trials, and three, how to choose from various catheter-based devices that are coming out in the market in terms of a team-based decision-making approach on what to do with the patient.

What according to you are some of the major trends in the market lately; these could be technological or any other prospect elements that have emerged lately.

Several trends have emerged over the last several years. The trend toward a less invasive approach to treating valvular heart disease is one of them. Currently, the trend is to determine whether catheter-based approaches to treating valve disease can be as effective as conventional surgery. This is driven by the volume growth of catheter-based treatment for bowel disease, which has catapulted catheter valve therapies over the last three years despite the pandemic. COVID-19 and its effects on resource utilization and other facets also played a pivotal role in driving a skyrocketing demand for less invasive approaches to treating cardiac disorders instead of open heart surgeries.

The other trend is the emergence of post-pandemic burnout in terms of procurement and resources, which hinder a surgeon’s ability to perform TAVR and TAVI procedures safely and effectively. At the same time, the healthcare space’s staffing constraints are also impacting the maintenance of desired patient throughput.

Would you like to talk about your latest initiative and how you are leveraging the insights gained from these trends to ensure success?

The whole concept of lifetime patient management with aortic valve disease is transformational because the TAVR is the default preferred option for most patients eligible for aortic stenosis treatment. However, due to the finite longevity of these valves, questions start to arise. These include, how to manage the patients when valves fail. Is there a need for corrective surgery to fix the problem? Can surgeons put another catheter valve inside? And how does a patient’s age change the viability of treatment options?

Currently, I am spearheading an NIH project that is in the process of putting together a group of multidisciplinary experts from around the world to workshop and discuss the issues related to catheter-based valvular treatment. Hopefully, this group will come up with a consensus on how to educate the medical community on the pros and cons of each treatment methodology for valvular heart disease.

We recognize that these problems will only become epidemic in the next five to ten years when the patients that underwent TAVI and TAVR procedures start asking questions about the longevity of their implants. But there are still numerous various elements to learn about through progressing clinical trials. I have been very fortunate to investigate this topic further and publish papers, which include a recent review in the journal of the American College of Cardiology, one of the highest-impact medical journals in this field.                 

How do you envision the future of cardiac care in the next couple of years?

There are three areas in terms of the future of medical technology in the valvular heart disease space. The first is diagnosis; we need to diagnose these patients and determine whether they have any subclinical damage in their hearts to enable faster intervention and better outcomes. There are many advances in imaging and biomarker analysis that are perfectly poised to transform the diagnosis of valvular heart disease.

Secondly, in terms of intervention, we need to preserve the lifetime management of these patients and leverage emerging technologies that fill in knowledge gaps not only in the aortic valve applications but also in mitric and tricuspid valve-related disorders. The third point is post-procedural management, which involves monitoring a patient’s life journey after successful implantation to ensure timely troubleshooting of any device-related issues and proactive medical management.

There are two more points I would like to mention, one is access to care and the other is integration between digital electronics and consumer health. With respect to accessibility, there is still a lot of work to be done for improving access to robust TAVR and TAVI procedures. Patients with poor socioeconomic backgrounds still struggle to gain access to much-needed treatment options, and the medical community must unite to mitigate this problem.

From a systems integration standpoint, AI, ML, and other leading-edge technologies are making it easier for caregivers to break down the barriers to accessing care and timely diagnosis. In pursuit of developing a technically robust portfolio of services, numerous device manufacturers are now collaborating with companies from tech-driven industries and cross-pollinating to make reliable treatment more accessible for all patients and families.

My advice is to keep your mind open, always look for new technologies, and opportunities, and follow them. Always remember that as a healthcare provider, your patient should always come first.