Guest: Dr. Ajay Kirtane, MD
Presenter: Neal Howard
Guest Bio: Ajay J. Kirtane, MD, SM specializes in complex coronary and peripheral vascular interventional procedures and assumed the directorship of the New York-Presbyterian / Columbia cardiac catheterization laboratories in 2015. In addition to his clinical commitments, Dr. Kirtane has a strong interest in clinical education and research, serving as Chief Academic Officer of the Center for Interventional Vascular Therapy. On the national and international level, he is a co-director of the Cardiovascular Research Foundation’s Transcatheter Cardiovascular Therapeutics meeting, has served as a director of several international, national, and regional educational meetings, and has participated on the program committees for the scientific sessions of both the American College of Cardiology and American Heart Association. Dr. Kirtane’s research interests are in clinical trial methodology and outcomes of device-based and pharmacologic interventions in Interventional Cardiology. He is/has been Principal Investigator for several multicenter trials of interventional devices and serves on the steering committees of several large-scale clinical trials in interventional cardiovascular medicine.
Segment Overview: Dr. Ajay Kirtane, MD, an Interventional Cardiologist and Endovascular Specialist discusses available treatments and alternatives to open-heart surgery.
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, so glad that you could join us today. With all things once again, related to our hearts. There are a lot of broken hearts that actually need to be fixed. Our guest today is Ajay Kirtane, an Interventional Cardiologist and Endovascular specialist. He’s joining us today to discuss some available treatments and some alternatives to open heart surgery. I’ll let Dr. Kirtane tell you all about himself. Welcome to the program Doctor.
Dr. Ajay Kirtane: I really appreciate being here. I am an interventional cardiologist, that means I do minimally invasive procedures but I also see patients in the outpatient setting. As a cardiologist, you get a lot of phone calls from family, friends and otherwise because heart disease is so prevalent. The reality is, this is heart month and so it’s just a time to increase awareness of heart disease. The potential downstream, bad effects from a heart attack or otherwise on how we can actually educate to prevent people from having heart attacks in the first place.
N: What are some of the available treatments? Maybe a briefly one that you frequently perform.
K: I think the key thing, the first treatment is to start early in the chain. If you recognized symptoms of a heart attack, you got to seek medical attention immediately. Call 911 and activate the healthcare system to work on your behalf. But once patients come in with heart attacks or chest pain symptoms, we typically take them to place called the cardiac catheterization laboratory or suite, where we do minimally invasive procedures to open up arteries that are blocked, that are causing the damage to the heart.
N: When we are talking minimally invasive, how minimally invasive? Are we not talking incisions that all are minimal incisions?
K: No incisions, no holes. What we aim to do nowadays, especially, is similar to how you have intravenous line or an IV place. We would go in and isolate just the artery in the wrist and basically access it, get in through the wrist and we actually can go in to the heart and do our work through minimally invasive, basically IV in the wrist. Once it’s done, patients can sit up, move around. It’s not like the old days where you have to do open heart surgery for this problem.
N: When you’re in the wrist in this artery, how are you seeing inside?
K: It’s amazing technology that’s been developed over many years but essentially on a screen, we’re looking in an x-ray. The x-ray allows us to steer a very fine wire, very soft wires to get from the wrist all the way into the heart and into the heart arteries themselves. Once we opened the artery we can actually deliver or advance a stent into the area of interest to open up that heart artery, the stored blood flow back to the muscle and then we take everything out. There’s only a small like a band aid on the wrist once that healed over the course for couple of hours.
N: You mentioned that once these procedures complete, the patient can sit up, walk around and they’re able to go home and I guess resume at least some semblance of a normal life or can they progress to join whatever they were doing before the heart problem in the first place?
K: I think here is where’s really important for the early activation, the medical system could take place, because if this is done early, the situation or we can save the most amount of the heart. If somebody has been having symptoms for a long period of time then the amount that we can save is less. Provided that the patient comes very rapidly to the hospital and to the emergency room and then to the catheterization lab, we expect full level of functioning for most patients after they undergo an exercise program and rehabilitation. It’s pretty amazing actually.
N: As the leading cause of death of both men and women here in the United States, heart disease, how cost effective is some of this new technology? It sounds very, very exciting, but is it something that all of us can look forward to getting the benefits of if necessary?
K: Unfortunately, it’s something where we could with preventative medicines most don’t have to look forward to it, but if it does occur to us then it’s something that for especially for heart attacks or patients with severe symptoms, it actually can be very cost effective and then case of the heart attacks, prolong patient’s life and their quality of life. I think that it’s one of those elements of medical care that we know can be under used and in fact if using the right patients is this benefit not only to the patient but also to the system. But then there are also some specific attribute to the procedure that has advanced more recently. It’s interesting to talk about those too, trying to make the procedure safe or more effective and more precise.
N: What would be at least one of those advances be that you see?
K: I think in the old days what we would do is we would just look at the x-ray imaging and rely upon those pictures alone to guide our treatment. There’d been numerous advances in what we call imaging technologies or ways to actually look within the blood vessels itself with either light-based technologies called the optical coherence tomography or ultrasound-based technology such as intravascular ultrasound. They’re all fancy words but what they basically enable us to do is to go beyond just the x-ray and to look within the artery itself. So, in its sense, we can check what we do once we put the stent then to be sure that the stent is the right size, it’s placed in the right place. There are no irregularities of the vessel before or after the stent and really can optimize our results.
N: Have you had an opportunity to use this technology on younger patients or is this something that normally takes place in older patients who have certain types of cardiovascular disease?
K: It actually works very well in all patient types. In fact, the younger patients, one can argue have the most to gain because you really want to make sure that the stent result that you get is lasting, because they have a lot of years ahead of them. This is not a doom-and-gloom diagnosis where somebody has a heart attack and their life is over. As we’ve said if you can get to the hospital early, we expect normal life expectancy and that’s what we’re doing such efforts to educate during heart month. But if you use this type of technology our feeling is that we can actually prolong how effective that stent works and hopefully avoid missing areas that we would not otherwise recognize if we were just using the traditional technology alone.
N: Where can our listeners go online and learn more about this technology?
K: There’s several resources for them. As the organization that I work with, we do a lot of research, all the Cardiovascular Research Foundations, so that’s www.crf.org. Then even just Google search or just YouTube searches on imaging technologies in the cardiac catheterization labs such as optical coherence tomography or intravascular ultrasound would actually be very, very useful. There are quite good videos that anyone can see if you search on those items.
N: Dr. Kirtane, thank you so much for talking with us today.
K: It’s a real pleasure being on.
N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Transcripts and audio of the program are available at hpr.fm and healthprofessioanalradio.com.au.