At The Heart of Innovation: Q&A w/ Cardiovascular Thought Leaders – Samir Kapadia, MD

At The Heart of Innovation: Q&A w/ Cardiovascular Thought Leaders – Samir Kapadia, MD

Nearly two years ago, when Samir Kapadia, MD, was appointed to Department Chair of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine in the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute, he couldn’t have been happier with the chance to foster the culture that has kept Cleveland Clinic the highest-ranking hospital in heart care since 1995. A proponent of feeding research interests alongside day-to-day care, Dr. Kapadia’s leadership inspires the department to put its best, most creative foot forward. In short, he preaches optimal treatment of patients with the solutions of today, alongside development of those required to treat the patients of tomorrow.   

Dr. Kapadia joined Cleveland Clinic’s staff as an interventional cardiologist in 2003. He has served as the Director of the Sones Cardiac Catheterization Laboratories since 2009 and as Section Head of Invasive and Interventional Cardiology since 2014. Dr. Kapadia earned his medical degree with highest honors from Smt. NHL Municipal Medical College in Gujarat, India, in 1989. In 1993, Dr. Kapadia completed his internship and residency in internal medicine at Baylor College of Medicine, where he was named Outstanding Resident. He also completed fellowships in cardiology in 1998 and interventional cardiology in 2000 at Cleveland Clinic, where he also served as Chief Interventional Fellow. Following the completion of his training, and before his return to Cleveland Clinic, Dr. Kapadia served as an interventional cardiologist at the VA Puget Sound Health Care System, in Seattle, from 2000 to 2003.

Dr. Kapadia’s specialty clinical interests include percutaneous treatment for valve disease, transcatheter aortic valve replacement (TAVR), MitraClip™ placement, complex coronary interventions, atrial septal defect (ASD) and patent foramen ovale (PFO) closure, carotid interventions, and peripheral interventions. Dr. Kapadia has performed over 1,000 TAVR procedures and thousands of other cardiovascular procedures throughout his career.

Though Dr. Kapadia presents a full caseload, oversees a department, and spends countless hours developing solutions, he never loses sight of the passion required in cardiovascular care.  “I love to get to know the patients and families well so that I can provide appropriate care and meet their expectations,” said Dr. Kapadia. “Procedural expertise is necessary for the best outcomes, but not enough; compassionate clinical care is an essential element that we should not ignore.” Below are some of Dr. Kapadia’s thoughts as they relate to innovation in the field of cardiovascular medicine – its presence, importance, and best examples at Cleveland Clinic:

Responses have been lightly edited for clarity and length.
 
Question: Tell us about your role at Cleveland Clinic. What’s it like to lead the team of cardiologists responsible for the enterprise’s 26 year ranking as the No. 1 hospital for cardiology and heart surgery?

Samir Kapadia, MD: We are the largest department in cardiology in the world probably – we have about 150 cardiologists in Cleveland. In addition, we have cardiologists at other satellite hospitals, large hospitals in Florida, Abu Dhabi, and now in London. So our staff is kind of a "who's who" of leaders in cardiology. These are passionate caregivers who work in many different areas of the heart and want to be the best in their particular field. They are involved in innovation, education, and patient care at the same time, and Cleveland Clinic is unique in the sense that it allows its cardiologists to do so. Even at my level, I am not 100% administrative in managing cardiology – I still see patients every day. I perform procedures almost four days a week, and I do it with passion. Whether it’s early mornings or late afternoons, I find ways to pay attention to all parts of my role.
Cleveland Clinic is also unique in that patients come from all over the world for care here. This gives us a great opportunity to form connections across the globe, but it’s also a huge responsibility when these patients travel so far and are depending on us for the final answer. The final answer being ‘the best treatment’ or ‘the most efficacious way to treat their heart problem.’ It’s a huge weight on our shoulders. For this reason, we are extremely accountable and demand a high quality of work. But it’s also fun – it is exciting to be at Cleveland Clinic.

Q: Here’s a question that’s a bit of a twofer: what are some of the challenges you’re seeing in cardiovascular medicine, and what efforts are being made to combat them?

SK: The main challenge remains, “What is the right treatment for the right patient?” When do we want to be aggressive? When do we want to be conservative? How do we treat patients such that we not only treat the current problem but also prevent future problems? How can we keep people healthy? So these are all areas of interest – from preventative cardiology, to treatment of acute problems, to secondary prevention.
It is a challenge because, many times, people who are extremely busy are unable to provide continued care – unable to see the patients as frequently as they have to. We are actively organizing all of our systems such that we are able to provide this continuity of care and personalized care, where we are able to identify and understand the individual problems, individual needs, family needs, etc. This is the unique responsibility of a physician, as you're not just delivering science; you are actually treating a human being – managing the individual, family, and cultural expectations.

As for the second part of your question, Cleveland Clinic is trying to innovate in two major focus areas. One is our ability to utilize computers. Machine learning and artificial intelligence have accelerated the way we can deliver care. We can think, we can organize our systems, and we can analyze the results of different tests with these solutions. So one of our major goals is to use machine learning and artificial intelligence in all different areas of cardiovascular medicine – from preventative cardiology, to imaging, to operational areas, to procedural areas, making them safe, effective, and efficient. We are working with many different industry partners as well as our own departments.

The second broad area is to understand the genetics of cardiovascular medicine. So you have environmental factors and genetic factors that lead to cardiovascular disease. We have some genetic diseases that we know of, but we also know that family history plays a role – from coronary artery disease, to atrial fibrillation, to dilated cardiomyopathy or other kinds of cardiomyopathy. Altogether, this is what we consider the genetic makeup of our patients. We want to have more in-depth insight and are investing a lot of effort in terms of getting the expertise, getting the computers, getting the data sets, getting enough patients to provide us with samples, etc. But it is a long-term investment. We need to collect this data, analyze the data, see what it pans out, but it is a definite priority for this year and a few years to come.

Q: As far as your specialty goes, with catheter-based solutions and percutaneous intervention for valvular disease – what’s all encompassed here? How have you seen this space develop?

SK: I tell a lot of people that the heart is like a room. There are doors, which are the valves – with blood coming from one door and going out the other. There are plumbing lines, and these are the arteries in the wall of the heart. There is electricity, which is the current of the heart – facilitating the function of the heart muscle, squeezing and pumping the blood. All of these areas can have difficulties in life. The doors can be leaky or may not be able to open fully – so the valves either need repaired or replaced. The electricity can short circuit – so you can put some insulation on the electric systems or put new wires via ablation or pacemakers. In the same way, if you have plumbing line-related blockage, this is what we call coronary artery disease. And the blockage can be opened up with balloons and stints, or you can put new plumbing lines – do bypass surgery.

The initial question is, “How do we tackle these arteries that are the size of a small wire at three millimeters in diameter?” In the past, we were opening the chest to see, understand, and repair the valves. Now, we are able to see extremely meticulously how the valve is functioning through advancements in x-ray and ultrasound systems – they’ve enabled decreases in invasiveness. So increased insight into the heart is number one.
The second part is that the devices have to be miniaturized, such that we don't have to open the chest to put things inside. Today, all devices are extremely miniaturized and precise. You’re able to manipulate it outside and navigate it through the body into the veins and arteries with the help of the imaging systems I mentioned before. This has changed the way we practice, and this has happened fast. The first initial stint in the United States became available in 1994, so you can imagine that in the last 25, 30 years, we have seen a massive development of these percutaneous devices.

The other great advancement is our ability to repair valves while the heart is beating. Today, we can go inside with different instruments and see the beating heart, and then put clips, valves, rings, etc. All of those things are possible because, again, you can visualize well, you can manipulate the devices, and the devices are now extremely small that they fit with minimal blockage.

So these are some huge advancements that we’ve seen even in my career and lifetime. At Cleveland Clinic, we are part of this in the sense that it is not just what we’ve seen and encountered; we’ve been part of the development. Cleveland Clinic attracts difficult problems, and the infrastructure is such that we are able to do new things with minimum risk, keeping it safe, effective, and innovative. We’ve worked with different valve companies, different investigators, different doctors, different surgeons, different imagers, major players in the medical device industry, etc. Cleveland Clinic has an Innovation department that helps facilitate and protect this work. I myself have several patents and enjoy finding new ways to do things. Together, we have been able to reach this new level in heart care, and we continue to work and grow together.
Dr. Kapadia’s most recent venture is that of Mitria Medial – a cardiac device startup developing a novel implant for transcatheter mitral valve repair. Through funding support by Cleveland Clinic and others, Mitria is currently working toward the technology’s initial clinical experience. For more information on Mitria Medical, contact Torey Hovest (hovestt@ccf.org).
 
Q: This juxtaposition of patient care and research is interesting. How do you foster that culture of innovation in your role? What practices or policies really drive that message home to your staff?

SK: There are thousands of doctors, thousands of smart doctors, good clinicians available in the world. But those that come to Cleveland Clinic to work don’t just want to see thousands of patients. They’re coming to Cleveland Clinic because they want to do something new. So my job is to identify that passion and ask people, "What can I do for you, so you can do things you’d love to do?" This is a very simple message because everybody is going to see patients, everybody is going to provide the most excellent care – and we monitor that. But on top of that, everybody should have a passion.

So I meet with all staff cardiologists and ask them about their passion. Some people want to innovate in patient care, some people want to be part of educational efforts, some people want to be operational experts – organizing and optimizing patients and appointments. Others have their eye on inventing new treatments, medications, devices, and methods. And the beauty is that everybody's an expert in something.

So when you walk in the hallways, you feel good and proud that the company you’re with is doing something new, innovative – which makes you feel like doing something new and innovative. And we attract the fellows, the trainees that want to do new things as well. They bring us energy, enthusiasm, and ideas. Altogether, innovation is a priority. And if we keep it as a priority, people are passionate and fulfilled, and they will deliver.

Q: Dr. Kapadia, any final thoughts?

SK: One other big asset of Cleveland Clinic is that we treat very influential people, very connected people, but these patients are extremely grateful to us. Many are our partners in the sense that they give philanthropic funds and provide us with the infrastructure and opportunity to do these new things. So this trust from our patients is also a very important part of our existence and growth.

Finally, I have to say that Cleveland Clinic, being the leader in cardiovascular medicine, is not in competition with any other hospital – we like to collaborate with everybody. Be it big institutions, small institutions, academic institutions, we want to work together. For every project that we do, we find a partner outside of Cleveland Clinic. This provides us a unique opportunity to expand our reach and presence of these innovations in the world. Whoever the best person or best institution is, we would love to collaborate, because there's nothing for us to prove and nothing for us to lose. We all want to get to that next level. In short, our patients and our collaborators are very useful assets in our growth and speed in the space.

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