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Drilling Down, Branching Out – Stuart F. Seides, MD

From the desk of Stuart F. Seides, MD Physician Executive Director MedStar Heart & Vascular Institute

In the not-too-distant past, a well-trained cardiologist could handle most patient diagnoses and treatment, and have a fairly complete understanding of the field. But the knowledge base has expanded exponentially in the last few decades, exceeding the absorption capacity of any one (even brilliant!) cardiologist.

The growth of the field has been organic, rooted in a strong core of information—the trunk from which branches and leaves have sprouted at an astonishing pace. Subspecialties and sub-subspecialties have emerged and cardiology practice—as well as cardiac surgical practice— continues to be reshaped for the benefit of patients. The generalist, often acting as the “quarterback” in an increasingly complex system of care, must have a broad understanding of the field along with its growing sub-specialties and, critically, must have ready access to the necessary advanced expertise.

This subspecialty expertise is the result of the research enterprise: It’s the engine that fuels knowledge expansion. I’m proud to say that MedStar Heart & Vascular Institute (MHVI), through our Research Network (MCRN), has played an important role in this remarkable evolution in cardiovascular medicine and surgery.

COMMUNICATION, DISSEMINATION

Perhaps nothing more dramatically demonstrates the growth of research and the increasing specialization of cardiovascular medicine than our annual Cardiovascular Research Technologies (CRT) conference. This year’s conference celebrated 40 years of percutaneous treatment options for heart disease. The CRT meeting has become one of the world’s largest conferences of its kind, attracting an international audience of more than 3,000.

During four days of diverse programming, the meeting promotes the rapid dissemination of cutting-edge research and technology, which will have an immediate impact on the practice of cardiology globally.

The development of percutaneous treatment options for structural heart defects is one of the most rapidly growing areas of interventional cardiology and was a featured section of the meeting’s curriculum. You can read about one of the most exciting of these new treatments in this issue of Cardiovascular Physician. The BASILICA interventional procedure uses an off-the-shelf technology in an innovative way to treat failing surgical bio-prosthetic aortic valves with TAVR, while avoiding the devastating consequences of an “old” valve leaflet blocking off a coronary artery. The technique was developed in part by MHVI’s Toby Rogers, MD, PhD, in collaboration with the National Institutes of Health, and is helping to transform treatment for patients with this often fatal complication.

The treatment of advanced heart failure is another area in which research has exploded. Where we could offer only generalized therapeutic interventions, we now are drilling down into sub-categories of this once devastating diagnosis and developing alternative treatments. Farooq Sheikh, MD, is spearheading the development of a specialized program for one of these sub-categories—the diagnosis and treatment of infiltrative cardiomyopathies—which disproportionately affects minority populations.

FINDING A NICHE

With the growth of sub-specialization and concurrent specialized training, cardiovascular physicians are finding their unique practice niches. At MedStar Union Memorial Hospital, Ankit Shah, MD, represents this growing cadre of specialized MHVI experts. He is a fellowship-trained sports cardiologist and, as director of MedStar Sports & Performance Cardiology, offers comprehensive cardiovascular care and physiologic testing for active individuals and athletes.

Increased fellowship training has become necessary to developing expertise in these specially focused areas, and new board certifications have followed suit. Leading medical centers such as MHVI have responded with increased training opportunities for physicians and other providers to bring the most sophisticated care to patients and our communities.