What are your current areas of research?
I am fortunate to be on the executive committee of the PARTNER trials and have worked, collaboratively, with our surgical, interventional colleagues, and our partners in industry. The current tack is to continue to investigate extending the potential of this novel technology from high to intermediate risk patients. In addition, we are working on further iterations of this technology and broadening its applications to other valvular diseases as well. I am also working with Dr Ajay Kirtane on the applications of ventricular unloading with the Impella technology, in limiting infarct size in a pilot study called the MINI-AMI study. In addition, I continue to work on advancing techniques on chronic total occlusions, with the applications of new wires and new methods and imaging techniques to help enhance our success rates.
As director of Vascular Intervention for New York Presbyterian, what are the rewards and challenges of being in this supervisory position?
There is no question that the day-to-day gratification of rendering care to some of the sickest patients in the world and beginning to apply advanced technologies to rectify, what are sometimes “hopeless” situations, is a daily gratification; one which I do not think I could ever give up. I am still a very busy interventional cardiologist, doing well over 600 interventions a year and really cannot get enough of that. Obviously, the challenges of this position involved in enlisting a complex organisation to focus on the patient when there are so many other demands on the direct caregivers, especially with the overwhelming amount of documentation and bureaucracy that is necessary to move the patient through the system. In addition the economic challenges are growing and, what Paul Teirstein refers to as the “war” against PCI, presents an enormous challenge in reeducating both physicians and the patients to the true benefits of our phenomenal interventional technologies.
Can you predict whether transcatheter valve implantation of aortic and mitral valves will eventually be better than surgery in standard risk patients?
I think this is a two-part question. The aortic procedures certainly, I think, can be extended into more intermediate risk patients, especially with the minimisation of the size of the devices, innovative new designs, as well as embolic protection. Whether it would be better in standard risk patients is an open question, given the extraordinary low mortalities seen in competent surgical hands. I think this is a way away, and I do not think that will happen within the decade. The mitrals have proven to be much more elusive. I think the idea of a transcatheter mitral valve is very appealing in its very early stages of development, but clearly almost a decade behind the aortics. I do believe the MitralClip is certainly an advance, but not for the standard risk patient. It will serve a robust niche in the area of functional mitral regurgitation in poor surgical candidates.
Interventional cardiologists now perform lower limb and renal interventions, two fields shared with interventional radiologists and vascular surgeons, in your opinion, who should do what?
While the short answer to this question is everyone should do everything, the one thing that we have certainly learned from the PARTNER trial is that collaboration between all elements of surgery, interventional and clinical cardiology and imaging, is essential for successful patient care. I believe this compartmentalisation into academic divisions in the field of vascular medicine really has to come to an end and cross training is the answer. These turf wars serve no one’s purpose, other than the certain individuals who are just interested in their territorial ascension.
What advice do you give young interventional cardiologists?
There are two dicta. First, always think about the patients’ needs. Their needs may not conform to your capabilities, and it is either up to improve your capabilities with new learning, or help develop the capabilities for the field with new research. Second, never cut corners. Being 90% right means that in 10 out of 100 patients you got it wrong. You have got to be systematic in your approach, and every individual, at a given point, has every possibility, in terms of diagnosis and complications. You cannot count on the patient to take care of you (for oversights); you have to take care of the patient.
What are your interests outside of medicine?
I do love skiing, though I do not get to do it as much as I used to. I still try to get about 10 to 15 days of skiing in a year. I like the steeps, hate cruising. I am lucky enough to be able to play tennis on a regular basis in the summer. While I am not very competitive, in the sense that I do not play to win, I do like good technique, and I do love running around the court on a hot day, and jumping into the pool. Politics are certainly a fascination of mine. I have had the good fortune to be involved with certain campaigns and politicians since my youth. I have had the good fortune to befriend some of the New York leaders, and participate and observe how decisions are made in the political system. Combining that with my interest in history, an election keeps my mind very engaged and active.
Education and training
1966–1970 BA, Cum Laude, Yale University, New Haven
1970–1974 MD, University of Pennsylvania School of Medicine, Philadelphia
1974–1975 Intern (Medicine), Presbyterian-University of Pennsylvania Medical Center, Philadelphia
1975–1977 Resident (Medicine), Presbyterian-University of Pennsylvania Medical Center
1978–1980 Cardiology Fellow, Presbyterian-University of Pennsylvania
1975–1980 Assistant instructor in Medicine, University of Pennsylvania, Philadelphia
1980–1981 Instructor (Medicine), Cornell University Medical College, New York
1981–1987 Assistant professor (Medicine), Cornell University Medical College
1987 Associate professor, Clinical Medicine, Cornell University Medical College
1993–1996 Clinical associate professor of Medicine, New York University School of Medicine, New York
1996–2004 Clinical Professor of Medicine, New York University School of Medicine, New York
2004–present Professor of Medicine, Columbia University Medical Center, New York
Hospital positions (selected)
1988–2004 Senior attending, Lenox Hill Hospital
2004–2010 Director, Center for Interventional Vascular Therapy (CIVT), NYPH/Columbia University Medical Center
2004–Present Director, Catheterization Lab, NYPH/Columbia University Medical Center
2010–2011 Director, Interventional Services, New York Presbyterian/Columbia, and New York Presbyterian/Weill Cornell Medical Center
2011–Present Chair, Executive Committee for Clinical Practice Development, NYPH/Columbia University Medical Center