Dr. Sameer Gafoor is the Medical Director of Structural Heart Disease at the Swedish Medical Center in Seattle, WA. Dr. Gafoor is passionate about the innovative structural heart field, which offers less invasive treatments for complex heart and valve conditions. As an editorial board member of Interventional Cardiology, he aims to bring the best global care practices to his patients.
Shortly after you completed your fellowship training, was there a therapy area or subject matter you wish you were taught or had more experience in?
My fellowship training was pretty comprehensive. I was able to gain significant experience in various areas, including heart failure, EP, coronary disease, pulmonary hypertension, and various other areas within cardiology. At the hospital center, we had a significant breadth and depth of experience.
One area where fellowship training could be improved is in the non-clinical aspects of medicine. This includes practice management, brand building, and business approaches to running a practice or being part of a larger organization. Gaining more experience in these areas would be very worthwhile as we develop high-quality programs and become great financial stewards of our responsibilities.
You're very well-published. Do you have any advice for physicians who are early in their careers and want to participate in clinical research?
For clinical trials, having an organization and infrastructure that can support them is crucial. At Swedish, we have a world-class research organization with a storied history of participating in clinical trials.
The first step is to ensure that your hospital has the necessary infrastructure to handle all the documentation and paperwork required to participate in clinical trials safely and effectively, with proper staffing. There are many small yet significant details, such as budgets, contracting, staffing, development, and follow-up, which are key aspects of study management but are often overlooked or less appreciated by physicians. So, that's step number one.
Step two is to start with something you already have substantial clinical experience in, where you have a good rapport with patients and a large patient volume. Then, reach out to companies to participate in studies. Don't try to take on too many at once. Focus on one area, gradually grow, and over time, excellence in one trial will lead to opportunities in others.
When it comes to collaborative research with other specialists, it's important to show up, be a good citizen, engage, participate, and dedicate your time. We all have busy schedules and various responsibilities, but being able to follow through on deadlines and commit to the work speaks volumes about what makes you successful.
Do you see promise in the use of intravascular lithotripsy (IVL) for structural heart applications?
The story of intravascular lithotripsy (IVL) is very exciting. This field has grown from coronary and peripheral spaces to becoming a compelling option in the structural heart space. As the field of aortic valve replacement has grown significantly, there are various ways to approach transcatheter aortic valve replacement (TAVR). However, due to issues in the peripheral vasculature, percutaneous alternative access methods are often necessary.
Nevertheless, the goal is to confidently perform a percutaneous transfemoral approach regularly, and reliably. IVL has revolutionized the field by enabling a predictable and safe approach. Many patients who previously required alternative access can now be treated percutaneously. In the early days of TAVR, up to 40-50% of procedures required transapical access, which is almost unheard of today. This change is largely due to device advancements and the evolution to smaller catheter sizes. However, we still need to match the anatomy, especially as we treat sicker patients with more complex conditions.
IVL ensures that the safety of TAVR is not limited by the safety of vascular access.
What business concepts do you wish you had a better grasp of when you finished your fellowship?
From a business perspective, I think there are two key concepts. One is really understanding P&L sheets, or profit and loss sheets, for your service line or sub-service line. As the director of Structural Heart at Providence Swedish, I've had to learn this on the job—with great support from our administration. Terms like ‘indirects’, ‘directs’, ‘EBITDA’ are initially unfamiliar to new cardiologists, but comprehending these allows us to hit the ground running, identify low-hanging fruit to decrease costs, and maximize value while increasing your cache. This not only generates positive revenue but also enhances your reputation within an organization as someone who values financial well-being as much as clinical well-being.
The second important concept is change management. To go far together requires a specific understanding of team dynamics, individual and collective team needs, and the best ways to implement changes. Techniques like smart goals and effective change management mechanisms are essential to be able to take a team or organization from one position to another. These are skills you can learn over time, either the hard way through your own mistakes or the easy way, by understanding these techniques from the start.
Many people come out of fellowship and find that things don't work as expected. They join a new program and feel like it's 10 years behind. It's crucial to patiently figure things out, build trust, and understand what is actually working in the program. After 6 to 12 months, you can start making small changes. Once you achieve success with those, people start valuing your opinion and trusting you with more significant changes, knowing that you’re not there to boil the ocean. It's about not being married to a specific solution but being committed to the process. This approach yields better ROI on the changes you want to implement.
Let's chat a little bit about your experience in Frankfurt. I'm sure there was a fair amount of contemplation before making that decision to pursue training there. For other residents or fellows considering a similar leap, are there certain non-negotiable things to consider? You once mentioned the fine line between a fool's errand and the pursuit of knowledge. How does one balance that?
It's important to understand that there are infinite ways to continue your education, sometimes at the expense of your own financial and mental well-being. Therefore, having mentors and guidance is crucial to help you determine the direction you want to go and the avenues to get there. For example, someone might decide to go into cardiology, become an interventional cardiologist, and focus on clinical excellence and structural heart disease. Then, they might want to transition into health care management, device innovation, or entrepreneurship, taking an idea and developing the business side of it. There are also regulatory opportunities.
You can cycle through these different areas and be in training for many years. The key is to understand what brings you joy and to expose yourself to various areas and opportunities. My current career path brings me immense joy. In 10 years, I might want to pivot slightly, or in 20 years, do something entirely different.
The arc of a career brings different opportunities. It's essential to decide at what point you'll apply the training you've received rather than continuously accumulating theoretical knowledge. The first five years of practice are like a tremendous fellowship in itself, making you independent and a critical thinker, able to integrate clinical history, anatomic risk factors, and procedural plans to achieve great patient outcomes. This takes repetition and helping your team grow to a place of flow and success.
After mastering one area, you might want to delve into innovation, regulatory work, or other fields. Each of these areas requires time, a network, and experience to be successful. Jumping from one area to another too quickly won't build trust or lead to good outcomes. Each field, whether it's regulatory, innovation, or healthcare administration, requires years to maintain competency and awareness of the specific cultural do's and don'ts.
Dr. Sameer Gafoor is the Medical Director of Structural Heart Disease at the Swedish Medical Center in Seattle, WA. Dr. Gafoor is passionate about the innovative structural heart field, which offers less invasive treatments for complex heart and valve conditions. As an editorial board member of Interventional Cardiology, he aims to bring the best global care practices to his patients.
Shortly after you completed your fellowship training, was there a therapy area or subject matter you wish you were taught or had more experience in?
My fellowship training was pretty comprehensive. I was able to gain significant experience in various areas, including heart failure, EP, coronary disease, pulmonary hypertension, and various other areas within cardiology. At the hospital center, we had a significant breadth and depth of experience.
One area where fellowship training could be improved is in the non-clinical aspects of medicine. This includes practice management, brand building, and business approaches to running a practice or being part of a larger organization. Gaining more experience in these areas would be very worthwhile as we develop high-quality programs and become great financial stewards of our responsibilities.
You're very well-published. Do you have any advice for physicians who are early in their careers and want to participate in clinical research?
For clinical trials, having an organization and infrastructure that can support them is crucial. At Swedish, we have a world-class research organization with a storied history of participating in clinical trials.
The first step is to ensure that your hospital has the necessary infrastructure to handle all the documentation and paperwork required to participate in clinical trials safely and effectively, with proper staffing. There are many small yet significant details, such as budgets, contracting, staffing, development, and follow-up, which are key aspects of study management but are often overlooked or less appreciated by physicians. So, that's step number one.
Step two is to start with something you already have substantial clinical experience in, where you have a good rapport with patients and a large patient volume. Then, reach out to companies to participate in studies. Don't try to take on too many at once. Focus on one area, gradually grow, and over time, excellence in one trial will lead to opportunities in others.
When it comes to collaborative research with other specialists, it's important to show up, be a good citizen, engage, participate, and dedicate your time. We all have busy schedules and various responsibilities, but being able to follow through on deadlines and commit to the work speaks volumes about what makes you successful.
Do you see promise in the use of intravascular lithotripsy (IVL) for structural heart applications?
The story of intravascular lithotripsy (IVL) is very exciting. This field has grown from coronary and peripheral spaces to becoming a compelling option in the structural heart space. As the field of aortic valve replacement has grown significantly, there are various ways to approach transcatheter aortic valve replacement (TAVR). However, due to issues in the peripheral vasculature, percutaneous alternative access methods are often necessary.
Nevertheless, the goal is to confidently perform a percutaneous transfemoral approach regularly, and reliably. IVL has revolutionized the field by enabling a predictable and safe approach. Many patients who previously required alternative access can now be treated percutaneously. In the early days of TAVR, up to 40-50% of procedures required transapical access, which is almost unheard of today. This change is largely due to device advancements and the evolution to smaller catheter sizes. However, we still need to match the anatomy, especially as we treat sicker patients with more complex conditions.
IVL ensures that the safety of TAVR is not limited by the safety of vascular access.
What business concepts do you wish you had a better grasp of when you finished your fellowship?
From a business perspective, I think there are two key concepts. One is really understanding P&L sheets, or profit and loss sheets, for your service line or sub-service line. As the director of Structural Heart at Providence Swedish, I've had to learn this on the job—with great support from our administration. Terms like ‘indirects’, ‘directs’, ‘EBITDA’ are initially unfamiliar to new cardiologists, but comprehending these allows us to hit the ground running, identify low-hanging fruit to decrease costs, and maximize value while increasing your cache. This not only generates positive revenue but also enhances your reputation within an organization as someone who values financial well-being as much as clinical well-being.
The second important concept is change management. To go far together requires a specific understanding of team dynamics, individual and collective team needs, and the best ways to implement changes. Techniques like smart goals and effective change management mechanisms are essential to be able to take a team or organization from one position to another. These are skills you can learn over time, either the hard way through your own mistakes or the easy way, by understanding these techniques from the start.
Many people come out of fellowship and find that things don't work as expected. They join a new program and feel like it's 10 years behind. It's crucial to patiently figure things out, build trust, and understand what is actually working in the program. After 6 to 12 months, you can start making small changes. Once you achieve success with those, people start valuing your opinion and trusting you with more significant changes, knowing that you’re not there to boil the ocean. It's about not being married to a specific solution but being committed to the process. This approach yields better ROI on the changes you want to implement.
Let's chat a little bit about your experience in Frankfurt. I'm sure there was a fair amount of contemplation before making that decision to pursue training there. For other residents or fellows considering a similar leap, are there certain non-negotiable things to consider? You once mentioned the fine line between a fool's errand and the pursuit of knowledge. How does one balance that?
It's important to understand that there are infinite ways to continue your education, sometimes at the expense of your own financial and mental well-being. Therefore, having mentors and guidance is crucial to help you determine the direction you want to go and the avenues to get there. For example, someone might decide to go into cardiology, become an interventional cardiologist, and focus on clinical excellence and structural heart disease. Then, they might want to transition into health care management, device innovation, or entrepreneurship, taking an idea and developing the business side of it. There are also regulatory opportunities.
You can cycle through these different areas and be in training for many years. The key is to understand what brings you joy and to expose yourself to various areas and opportunities. My current career path brings me immense joy. In 10 years, I might want to pivot slightly, or in 20 years, do something entirely different.
The arc of a career brings different opportunities. It's essential to decide at what point you'll apply the training you've received rather than continuously accumulating theoretical knowledge. The first five years of practice are like a tremendous fellowship in itself, making you independent and a critical thinker, able to integrate clinical history, anatomic risk factors, and procedural plans to achieve great patient outcomes. This takes repetition and helping your team grow to a place of flow and success.
After mastering one area, you might want to delve into innovation, regulatory work, or other fields. Each of these areas requires time, a network, and experience to be successful. Jumping from one area to another too quickly won't build trust or lead to good outcomes. Each field, whether it's regulatory, innovation, or healthcare administration, requires years to maintain competency and awareness of the specific cultural do's and don'ts.
Dr. Sameer Gafoor is the Medical Director of Structural Heart Disease at the Swedish Medical Center in Seattle, WA. Dr. Gafoor is passionate about the innovative structural heart field, which offers less invasive treatments for complex heart and valve conditions. As an editorial board member of Interventional Cardiology, he aims to bring the best global care practices to his patients.
Shortly after you completed your fellowship training, was there a therapy area or subject matter you wish you were taught or had more experience in?
My fellowship training was pretty comprehensive. I was able to gain significant experience in various areas, including heart failure, EP, coronary disease, pulmonary hypertension, and various other areas within cardiology. At the hospital center, we had a significant breadth and depth of experience.
One area where fellowship training could be improved is in the non-clinical aspects of medicine. This includes practice management, brand building, and business approaches to running a practice or being part of a larger organization. Gaining more experience in these areas would be very worthwhile as we develop high-quality programs and become great financial stewards of our responsibilities.
You're very well-published. Do you have any advice for physicians who are early in their careers and want to participate in clinical research?
For clinical trials, having an organization and infrastructure that can support them is crucial. At Swedish, we have a world-class research organization with a storied history of participating in clinical trials.
The first step is to ensure that your hospital has the necessary infrastructure to handle all the documentation and paperwork required to participate in clinical trials safely and effectively, with proper staffing. There are many small yet significant details, such as budgets, contracting, staffing, development, and follow-up, which are key aspects of study management but are often overlooked or less appreciated by physicians. So, that's step number one.
Step two is to start with something you already have substantial clinical experience in, where you have a good rapport with patients and a large patient volume. Then, reach out to companies to participate in studies. Don't try to take on too many at once. Focus on one area, gradually grow, and over time, excellence in one trial will lead to opportunities in others.
When it comes to collaborative research with other specialists, it's important to show up, be a good citizen, engage, participate, and dedicate your time. We all have busy schedules and various responsibilities, but being able to follow through on deadlines and commit to the work speaks volumes about what makes you successful.
Do you see promise in the use of intravascular lithotripsy (IVL) for structural heart applications?
The story of intravascular lithotripsy (IVL) is very exciting. This field has grown from coronary and peripheral spaces to becoming a compelling option in the structural heart space. As the field of aortic valve replacement has grown significantly, there are various ways to approach transcatheter aortic valve replacement (TAVR). However, due to issues in the peripheral vasculature, percutaneous alternative access methods are often necessary.
Nevertheless, the goal is to confidently perform a percutaneous transfemoral approach regularly, and reliably. IVL has revolutionized the field by enabling a predictable and safe approach. Many patients who previously required alternative access can now be treated percutaneously. In the early days of TAVR, up to 40-50% of procedures required transapical access, which is almost unheard of today. This change is largely due to device advancements and the evolution to smaller catheter sizes. However, we still need to match the anatomy, especially as we treat sicker patients with more complex conditions.
IVL ensures that the safety of TAVR is not limited by the safety of vascular access.
What business concepts do you wish you had a better grasp of when you finished your fellowship?
From a business perspective, I think there are two key concepts. One is really understanding P&L sheets, or profit and loss sheets, for your service line or sub-service line. As the director of Structural Heart at Providence Swedish, I've had to learn this on the job—with great support from our administration. Terms like ‘indirects’, ‘directs’, ‘EBITDA’ are initially unfamiliar to new cardiologists, but comprehending these allows us to hit the ground running, identify low-hanging fruit to decrease costs, and maximize value while increasing your cache. This not only generates positive revenue but also enhances your reputation within an organization as someone who values financial well-being as much as clinical well-being.
The second important concept is change management. To go far together requires a specific understanding of team dynamics, individual and collective team needs, and the best ways to implement changes. Techniques like smart goals and effective change management mechanisms are essential to be able to take a team or organization from one position to another. These are skills you can learn over time, either the hard way through your own mistakes or the easy way, by understanding these techniques from the start.
Many people come out of fellowship and find that things don't work as expected. They join a new program and feel like it's 10 years behind. It's crucial to patiently figure things out, build trust, and understand what is actually working in the program. After 6 to 12 months, you can start making small changes. Once you achieve success with those, people start valuing your opinion and trusting you with more significant changes, knowing that you’re not there to boil the ocean. It's about not being married to a specific solution but being committed to the process. This approach yields better ROI on the changes you want to implement.
Let's chat a little bit about your experience in Frankfurt. I'm sure there was a fair amount of contemplation before making that decision to pursue training there. For other residents or fellows considering a similar leap, are there certain non-negotiable things to consider? You once mentioned the fine line between a fool's errand and the pursuit of knowledge. How does one balance that?
It's important to understand that there are infinite ways to continue your education, sometimes at the expense of your own financial and mental well-being. Therefore, having mentors and guidance is crucial to help you determine the direction you want to go and the avenues to get there. For example, someone might decide to go into cardiology, become an interventional cardiologist, and focus on clinical excellence and structural heart disease. Then, they might want to transition into health care management, device innovation, or entrepreneurship, taking an idea and developing the business side of it. There are also regulatory opportunities.
You can cycle through these different areas and be in training for many years. The key is to understand what brings you joy and to expose yourself to various areas and opportunities. My current career path brings me immense joy. In 10 years, I might want to pivot slightly, or in 20 years, do something entirely different.
The arc of a career brings different opportunities. It's essential to decide at what point you'll apply the training you've received rather than continuously accumulating theoretical knowledge. The first five years of practice are like a tremendous fellowship in itself, making you independent and a critical thinker, able to integrate clinical history, anatomic risk factors, and procedural plans to achieve great patient outcomes. This takes repetition and helping your team grow to a place of flow and success.
After mastering one area, you might want to delve into innovation, regulatory work, or other fields. Each of these areas requires time, a network, and experience to be successful. Jumping from one area to another too quickly won't build trust or lead to good outcomes. Each field, whether it's regulatory, innovation, or healthcare administration, requires years to maintain competency and awareness of the specific cultural do's and don'ts.
Fun, Insightful Interviews with the
World's Brightest Physicians
Delivered straight to your inbox. Completely free. No spam.
Fun, Insightful Interviews with the
World's Brightest Physicians
Delivered straight to your inbox. Completely free. No spam.
Fun, Insightful Interviews with the
World's Brightest Physicians
Delivered straight to your inbox. Completely free. No spam.
You're a specialist in a field that sees constant changes. Do you have any tips or recommendations for other physicians on how to best keep up with advancements?
There are three main ways new technology can emerge. First, in areas where there was previously nothing available. For example, tricuspid repair and replacement recently got approved devices. Second, in the form of additive or iterative technology in known areas of clinical care, such as a new type of heart valve. Third, in entirely novel areas without any prior predicate, like intracardiac shunts or the Impella pump, which was a revolutionary device when first introduced.
It's easier to implement technology that has predicates, like a new stent or valve that's an iteration of an existing one. It's harder when it's a new space, and much harder when there's no precedent for the technology at all.
The key point is ensuring patient safety. You are responsible for making sure the patient undergoes a safe procedure with effective outcomes. No one else will care about this as much as you will. Additionally, you must understand the team members and capital equipment needed. Implementing structural heart technologies requires close communication with cardiothoracic surgeons, cardiac anesthesiologists, imagers, cath lab teams, echo teams, ICU, and floor care teams. For instance, the needs for a mitral valve replacement from an ICU perspective are very different from those for a mitral valve repair due to the hemodynamic challenges involved.
Financial viability is also crucial. Even if a technology is excellent, it won't be sustainable if it's not financially feasible. This could jeopardize other aspects of the program you've worked hard to build.
At the end of the day, a new technology should either treat more people, treat people safer, or treat people faster. If it doesn't meet any of these criteria, you need to question its value. Not every technology will provide value, and it's your job to figure out whether it can provide safe and effective care for your patients. All these aspects must be present for a technology to be successful.
Let’s transition to some fun, rapid-fire questions. First, do you listen to music while in the cath lab or OR? If so, what are some songs that are high on the playlist?
I usually let the cath lab pick the music. If I had to choose, old-school 90s hip hop or top 40 hits would probably be my go-to genre. Those are the two categories most commonly played in the lab.
How about movies? If you happen to have a weekend off and there's a movie on TV, are there a few that you'd sit down and actually watch?
I really enjoy The Dark Knight trilogy. It's a fantastic series. There are many movie choices that come to mind, but the one I was watching recently was this.
If you could go back to your mid to late 20s, maybe when you were in medical school or shortly after, is there one thing you would whisper in the ear of your younger self?
I tell this to myself now and it remains true at every level. At multiple points in our lives, we plan out what our future should be, and we expect those plans to pan out. What I've learned is that if I look back 10 years, or even just one or two years, about a third of what I predicted to be true actually happened, a third of what I predicted never happened, and a third of things that I never could have predicted did happen.
What that means is that while you can predict a lot, you will be successful at some things, fail at others, and it will be very hard to know which will be which. The real key is your effort and your ability to pivot towards your true north. It's crucial to figure out what your true north is.
Any congresses, events, research, or podium presentations that you want us to mention or raise awareness about?
Yes, I think the two main congresses that have been very instrumental in my learning are the CSI and CRF conferences. The CSI conference in Frankfurt, America, and other locations has been absolutely great. The CRF is the foundation of our field in the United States, and the New York Valves and TCT conferences are essential for education, cooperation, and growth, both now and in the future.
From a clinical research perspective, mitral and tricuspid valve repair and replacement are amazing fields that will continue to grow in terms of safety, efficacy, timing, and proper anatomic and clinical substrates. An exciting area coming up is aortic regurgitation research. These are all areas in which we are heavily invested.
You're a specialist in a field that sees constant changes. Do you have any tips or recommendations for other physicians on how to best keep up with advancements?
There are three main ways new technology can emerge. First, in areas where there was previously nothing available. For example, tricuspid repair and replacement recently got approved devices. Second, in the form of additive or iterative technology in known areas of clinical care, such as a new type of heart valve. Third, in entirely novel areas without any prior predicate, like intracardiac shunts or the Impella pump, which was a revolutionary device when first introduced.
It's easier to implement technology that has predicates, like a new stent or valve that's an iteration of an existing one. It's harder when it's a new space, and much harder when there's no precedent for the technology at all.
The key point is ensuring patient safety. You are responsible for making sure the patient undergoes a safe procedure with effective outcomes. No one else will care about this as much as you will. Additionally, you must understand the team members and capital equipment needed. Implementing structural heart technologies requires close communication with cardiothoracic surgeons, cardiac anesthesiologists, imagers, cath lab teams, echo teams, ICU, and floor care teams. For instance, the needs for a mitral valve replacement from an ICU perspective are very different from those for a mitral valve repair due to the hemodynamic challenges involved.
Financial viability is also crucial. Even if a technology is excellent, it won't be sustainable if it's not financially feasible. This could jeopardize other aspects of the program you've worked hard to build.
At the end of the day, a new technology should either treat more people, treat people safer, or treat people faster. If it doesn't meet any of these criteria, you need to question its value. Not every technology will provide value, and it's your job to figure out whether it can provide safe and effective care for your patients. All these aspects must be present for a technology to be successful.
Let’s transition to some fun, rapid-fire questions. First, do you listen to music while in the cath lab or OR? If so, what are some songs that are high on the playlist?
I usually let the cath lab pick the music. If I had to choose, old-school 90s hip hop or top 40 hits would probably be my go-to genre. Those are the two categories most commonly played in the lab.
How about movies? If you happen to have a weekend off and there's a movie on TV, are there a few that you'd sit down and actually watch?
I really enjoy The Dark Knight trilogy. It's a fantastic series. There are many movie choices that come to mind, but the one I was watching recently was this.
If you could go back to your mid to late 20s, maybe when you were in medical school or shortly after, is there one thing you would whisper in the ear of your younger self?
I tell this to myself now and it remains true at every level. At multiple points in our lives, we plan out what our future should be, and we expect those plans to pan out. What I've learned is that if I look back 10 years, or even just one or two years, about a third of what I predicted to be true actually happened, a third of what I predicted never happened, and a third of things that I never could have predicted did happen.
What that means is that while you can predict a lot, you will be successful at some things, fail at others, and it will be very hard to know which will be which. The real key is your effort and your ability to pivot towards your true north. It's crucial to figure out what your true north is.
Any congresses, events, research, or podium presentations that you want us to mention or raise awareness about?
Yes, I think the two main congresses that have been very instrumental in my learning are the CSI and CRF conferences. The CSI conference in Frankfurt, America, and other locations has been absolutely great. The CRF is the foundation of our field in the United States, and the New York Valves and TCT conferences are essential for education, cooperation, and growth, both now and in the future.
From a clinical research perspective, mitral and tricuspid valve repair and replacement are amazing fields that will continue to grow in terms of safety, efficacy, timing, and proper anatomic and clinical substrates. An exciting area coming up is aortic regurgitation research. These are all areas in which we are heavily invested.
You're a specialist in a field that sees constant changes. Do you have any tips or recommendations for other physicians on how to best keep up with advancements?
There are three main ways new technology can emerge. First, in areas where there was previously nothing available. For example, tricuspid repair and replacement recently got approved devices. Second, in the form of additive or iterative technology in known areas of clinical care, such as a new type of heart valve. Third, in entirely novel areas without any prior predicate, like intracardiac shunts or the Impella pump, which was a revolutionary device when first introduced.
It's easier to implement technology that has predicates, like a new stent or valve that's an iteration of an existing one. It's harder when it's a new space, and much harder when there's no precedent for the technology at all.
The key point is ensuring patient safety. You are responsible for making sure the patient undergoes a safe procedure with effective outcomes. No one else will care about this as much as you will. Additionally, you must understand the team members and capital equipment needed. Implementing structural heart technologies requires close communication with cardiothoracic surgeons, cardiac anesthesiologists, imagers, cath lab teams, echo teams, ICU, and floor care teams. For instance, the needs for a mitral valve replacement from an ICU perspective are very different from those for a mitral valve repair due to the hemodynamic challenges involved.
Financial viability is also crucial. Even if a technology is excellent, it won't be sustainable if it's not financially feasible. This could jeopardize other aspects of the program you've worked hard to build.
At the end of the day, a new technology should either treat more people, treat people safer, or treat people faster. If it doesn't meet any of these criteria, you need to question its value. Not every technology will provide value, and it's your job to figure out whether it can provide safe and effective care for your patients. All these aspects must be present for a technology to be successful.
Let’s transition to some fun, rapid-fire questions. First, do you listen to music while in the cath lab or OR? If so, what are some songs that are high on the playlist?
I usually let the cath lab pick the music. If I had to choose, old-school 90s hip hop or top 40 hits would probably be my go-to genre. Those are the two categories most commonly played in the lab.
How about movies? If you happen to have a weekend off and there's a movie on TV, are there a few that you'd sit down and actually watch?
I really enjoy The Dark Knight trilogy. It's a fantastic series. There are many movie choices that come to mind, but the one I was watching recently was this.
If you could go back to your mid to late 20s, maybe when you were in medical school or shortly after, is there one thing you would whisper in the ear of your younger self?
I tell this to myself now and it remains true at every level. At multiple points in our lives, we plan out what our future should be, and we expect those plans to pan out. What I've learned is that if I look back 10 years, or even just one or two years, about a third of what I predicted to be true actually happened, a third of what I predicted never happened, and a third of things that I never could have predicted did happen.
What that means is that while you can predict a lot, you will be successful at some things, fail at others, and it will be very hard to know which will be which. The real key is your effort and your ability to pivot towards your true north. It's crucial to figure out what your true north is.
Any congresses, events, research, or podium presentations that you want us to mention or raise awareness about?
Yes, I think the two main congresses that have been very instrumental in my learning are the CSI and CRF conferences. The CSI conference in Frankfurt, America, and other locations has been absolutely great. The CRF is the foundation of our field in the United States, and the New York Valves and TCT conferences are essential for education, cooperation, and growth, both now and in the future.
From a clinical research perspective, mitral and tricuspid valve repair and replacement are amazing fields that will continue to grow in terms of safety, efficacy, timing, and proper anatomic and clinical substrates. An exciting area coming up is aortic regurgitation research. These are all areas in which we are heavily invested.
