Right now is a transformational time for the minimally-invasive treatment of heart valve defects including aortic stenosis and mitral regurgitation. During the past 10 years, the use of transcatheter devices to replace and repair valvular disease has skyrocketed. For example, the number of transcatheter aortic valve replacements (TAVR) has soared from 4,600 cases in 2012 to over 100,000 cases in 2023, according to the Journal of the American College of Cardiology.

Interestingly… During a recent survey of 988 patients in the HeartValveSurgery.com community, we learned that 53% of patients are not aware of the critical role of interventional cardiologists for the lifetime management of heart valve disease. For this specific reason, we were thrilled when Dr. Raj Makkar, a world-renowned interventional cardiologist who has performed over 7,000 transcatheter heart valve therapies, invited us to spend an entire day with his team at Cedars-Sinai Medical Center in Los Angeles, California.

Key Learnings About Interventional Cardiologists

Here are key learning about the role and importance of interventional cardiologists for the lifetime management of heart valve disease:

• What does an interventional cardiologist do? According to a recent survey we did of the patients in our community, only a surprising 53 percent know what an interventional cardiologist does. Dr. Makkar explained, “An interventional cardiologist does the most minimally invasive cardiac surgery without any incisions in the chest.” He said that they can fix a leaky valve, a narrow valve, or a blockage in the artery all with a puncture to the artery of the wrist or groin. “It’s what the surgeons do, but we do it absolutely minimally invasively.”

• What is the interventionist role within a heart team? “It’s very important to point out that the best management of patients occurs with the heart team approach,” said Dr. Makkar. He explained that the heart team consists of the interventional cardiologists, the surgeons, the general cardiologist, and the patient’s primary physicians. There are also imaging specialists involved who do CT angiography and echocardiograms. Essentially, the interventional cardiologist does the procedure but has this entire heart team to help with the overall management of the patient.

• Why have interventional cardiologists become so important for treating heart valve disease? “Fortunately for patients, the technology has evolved,” said Dr. Makkar. “I think the interventional cardiologists have had this goal and objective of doing what the cardiac surgeons have done with less invasive approaches. I have to say that both the surgeons and interventional cardiologists have worked together because these patients are less ideal candidates for surgery with the aging population. The technology has evolved to fill in that gap and provide more alternatives to our patients who are much older and would be less ideal for surgery.” Makkar explained that in addition to the evolving technology, patients want to achieve a solution to their problem with the least invasive approach. “So all of these things have come together and increased the role of interventional procedures in patients with cardiac disease,” he said.

Dr. Raj Makkar in the Catheter Lab

• What are the benefits that patients experience with transcatheter devices? “I think the most important benefit for patients is the minimal invasiveness,” Dr. Makkar said. “If we can do a procedure without big incisions and general anesthesia, that translates into much faster recovery for patients. Early ambulation, early discharge, and getting back to work are all very positive attributes for the patients,” he explained. “I think the important thing is to make sure we do not sacrifice efficacy for convenience.”

• What is a typical day like in your life here at Cedars? When do you get here, and can you talk about the procedures? “Well, this morning we all got together with a heart team approach,” he said. “We discussed patients who had mitral and tricuspid valve issues. As a group, we reviewed their imaging findings and decided the best possible approach by determining whether they would be good candidates for surgery, transcatheter options, or if they needed to get into clinical trials.” He continued, “Today happens to be an interesting day in our lab. We are going to do three tricuspid valve replacement procedures. We have two patients who will undergo transcatheter aortic valve replacement, and we have a patient who will undergo transcatheter mitral valve edge-to-edge repair. It’s a fun day in the cath lab.” Makkar described some of his cases that day, and we watched a live transcatheter mitral valve repair case. The patient had regurgitation, and the repair was to help minimize that by clipping the mitral valve leaflets. He used a Pascal device made by Edwards Lifesciences. The entire procedure was done without an incision to the ribs or chest.

• Although we were able to see the procedures, I wanted to know firsthand from Dr. Makkar how he thought they went: “I’m glad you had a good time watching, and I’m still amazed by these procedures,” he said. “I do them every day, and today, we had a good day. Thankfully, all the patients did well, so I’m hoping we can discharge at least four of these seven patients who’ve undergone these transcatheter heart valve procedures tomorrow and hopefully the rest the day after. So, all in all, it was a good day.”

Dhairya Patel, MPH, Me, Raj Makkar, MD, Aakriti Gupta, MD and Moody Makar, MD

• When does Dr. Makkar’s typical day end? “I’m typically done with my procedures around 7 pm, and then I spend time with the fellows and go over the plan for the next day,” he explained. “There is also academic work that goes on. The academic work of research and advancing some of these things occurs on the weekends and at night. Thankfully, it doesn’t feel like hard work. I feel very fortunate to have the privilege of doing what I do and that it really helps patients.”

Thanks Dr. Makkar and Cedars-Sinai Medical Center!

On behalf of all the patients in the HeartValveSurgery.com Community and patients all over the world, thank you so much for your time today, Dr. Raj Makkar!  Also, thank you Cedars-Sinai Medical Center, for caring for heart valve patients!

Related Links:

• Inside Access to Dr. Raj Makkar’s Heart Valve Catheter Lab at Cedars Sinai!
• See Dr. Raj Makkar’s Interactive Interventional Cardiologist Profile

Keep on tickin’ Dr. Makkar!
Adam

P.S. For the deaf and hard-of-hearing members of our community, I have provided a transcript of this video below.