Chaim Lotan is the director of the Heart Institute of The Hadassah-Hebrew University Medical Center (Jerusalem, Israel) and is also course co-director for the Innovations in Cardiovascular Intervention (ICI) meeting (1–3 December, Tel Aviv, Israel). He spoke to Cardiovascular News about his career highlights and the goals of this year’s ICI meeting
Why did you decide to become a doctor and why in particular, did you choose to specialise in interventional cardiology?
I dreamed of becoming a physician since childhood; the dream grew stronger when a friend of mine decided to go to medical school. His enthusiasm was contagious and gave me the extra push I needed to turn my dream into reality.
I chose to specialise in interventional cardiology during my cardiology internship when the Prime Minister of Israel at that time was hospitalised in the unit following a heart attack. The mystery, dispute and dynamic issues surrounding his treatment intrigued me.
When I started my fellowship in cardiology in 1983, interventional cardiology was in its beginnings. Hadassah was one of the first medical centres to be involved with percutaneous transluminal coronary angioplasty. For me as a “frustrated” surgeon at the time, it was fascinating to see that there are less invasive ways to treat and diagnose patients.
Who have been your career mentors?
I am fortunate to have met many wonderful teachers and mentors throughout my years of study and beyond. Two distinguished examples came from the very department I am privileged to head today. The first, Dr Mervyn Gottesman, was the previous department head. He came from South Africa to Israel and was always chasing after the newest cutting edge technology, trying to broaden his horizon and stay updated on the latest information.
The second is Marty Leon, who is not only a close personal friend, but serves as a true role model for me and others, not only in the field of cardiology but also in education and innovation. He encouraged me to get heavily involved and to launch the ICI meeting.
In your view, what has been the most important development in interventional cardiology?
The stent has revolutionised our view of interventional cardiology. I still remember our frustration in the early days with plain old balloon angioplasty—the high failure rate, both acute and chronic, and the relatively high need for emergency surgery after the procedure. The invention of the stent and the ability to have a scaffold for the artery completely changed the success of these procedures.
Of the research you have been involved in, which piece are you most proud of and why?
In the basic science lab, we have been studying the pathogenesis of aortic valve stenosis. We developed a unique animal model of diet-induced reversible renal failure and aortic stenosis, supporting the role of inflammatory changes involved in the transformation of normal interstitial valve cells into a pathological bony phenotype. This model may help us better understand and perhaps find ways to medically prevent and treat aortic stenosis, which are not available at present.
In the interventional arena, one of the more fascinating involvements was with the early development of drug-eluting stents, which really revolutionised coronary artery intervention. More recently, I have been heavily involved in the development of the MGuard stent system (InspireMD), a unique mesh-covered stent designed to prevent distal embolisation. I truly believe this technology might be revealed as a very good solution for treating patients with a high risk for embolidation such as patients with acute myocardial infarction. Even more exciting, looking towards the future, it may hold large future implications in carotid stenting, as MGuard comes “armed” with a protective net that remains in place after the procedure, which is most important in carotid stenting where late thrombosis is common.
You are currently involved in the NOBORI II and SOLID studies. What are the goals of these studies and when will the results be available?
NOBORI II is a multicentre observational study of the safety and efficacy of the drug-eluting Norbori stent, which has been shown to have quite good characteristics of a third generation drug-eluting stent. Recruitment ended in 2009, and the study has clinical follow-up for one, six and 12 months and two, three, four and five years long-term, so we look towards results in 2015.
The SOLID study investigates the effect of the anti-inflammatory drug darapladib in acute coronary syndrome. The recruitment stage of the study was terminated early due to safety concerns over adverse observations in high-dosage treated study rodents, and patients are being carefully monitored for evaluation of this risk. The current aim is for a five-year follow-up.
What do you think has been the most interesting paper in the past year?
I cannot really quote one specifically “most” important paper, so I would rather mention three important topics in the recent literature largely impacting the practice of interventional cardiology:
a) The FREEDOM trial (which we at Hadassah were a part of) that clearly showed the superiority of coronary artery bypass grafting over percutaneous coronary intervention (PCI) in diabetic patients with multivessel disease
b) FAME II has shown the importance of fractional flow reserve in intermediate/questionable lesions in predicting future events
c) In transcatheter aortic valve implantation (TAVI) we did not have one recent “major” paper, as PARTNER II is still underway, but there has been a large flood of subtopic papers (on cases, complications, prognosis, patient subsets etc.) attesting to the revolution this procedure has brought to the treatment of aortic stenosis.
You are course co-director of the ICI meeting. What are the overall aims of the meeting?
The ICI meeting focuses on innovative technology and therapies in the field of cardiology, and is the foremost meeting on innovation in the field. The programme includes presentations of new therapies and research at various levels of development, thematic live case presentations to present the impact of these technologies on current and future therapy, and clinical overviews on specific topics with an emphasis on future perspectives presented by leading international experts. The popular “Technology Parade” offers biomedical technology start-ups from around the world the opportunity to present their latest developments. A recent add-on to the meeting is the prestigious “ICI Start-up of the Year” competition.
ICI is dedicated to the innovations in the cardiovascular world, and we have added a new track session to the programme called “Connected Health”. This exciting new topic covers the expanding world of digital health, mobile health and telemedicine, all of which is quickly becoming a major field and there is much demand among start-ups to understand this quickly developing market. We are planning several sessions on such topics as Smartphone medical applications, transmission security, implantable sensors etc.
The ICI meeting attracts cardiologists, innovative scientists, biomedical engineers, financial investors and representatives from the medical industry—over 1,000 attendees.
What are the specific themes of this year’s meeting?
Among other themes, this year we are concentrating on the brain as the next target for future interventions as well as the on-going revolution of digital connected health and autonomic sympathetic modulation.
The ICI Innovation of the Year Award is the among world’s most prestigious awards for medical intervention Startups. Finalists have the opportunity to meet with a world-class panel of clinical and commercial experts face-to-face, and have to prove the merit of their idea—and receive valuable advice and guidance in the process, which is an opportunity that money cannot buy. Winning an ICI Innovation Award offers unparalleled clinical and commercial validation, as well as valuable exposure to an international audience that should help spur investors and other interested parties to take note of the innovation, and help it progress towards benefiting patients.
As someone who has been involved with several innovations, what advice would you give to an interventional cardiologist about how they can develop an idea into an actual product?
Team up with the best people available and never give up. We have not yet entered significantly into the field of brain interventions, especially during acute stroke. We must conduct research to better understand the needs of patients suffering a stroke or bleeding aneurysm.
As well as ICI, you are an associate director for TCT (27 October–1 November, San Francisco, USA). What, in your view, is the value of attending medical conferences?
There are many values to attending medical conferences; inspiring mutual cooperation is one of them. The world of interventional cardiology is a small one and it has been advancing nicely, especially in Far Eastern countries. Gathering at a conference allows professionals from diverse places worldwide to learn from each other about clinical experiences, procedures, latest research, newest technologies and different techniques. They would not have the opportunity otherwise to meet and form so many bonds that can strengthen their own practice, while also leading to more progress and advancement in the field. This is of course in addition to the primary purpose of the conferences of providing a top-level concentrated educational experience on a wide variety of subtopics.
What has been your most memorable case and why?
I will share with you two extreme cases that describe the remarkable changes the field of interventional cardiology has undergone in the last two decades.
The first occurred about 20 years ago: a relatively young gentleman came in with a small anterior myocardial infarction. We catheterised him a few days later and opened with a balloon in the left anterior descending artery, but the patient occluded the artery a few hours later (probably due to dissection). Since all other attempts to open the artery failed, he was sent to bypass surgery. Unfortunately he barely survived the surgery due to large infarct, and after several days in the ICU, he died of heart failure without being able to find him a donor. This was a depressing case that stayed with me for a long time, together with the feeling of helplessness at not being able to save him.
On the other hand, about eight years ago, an extremely smart, active, and coherent 92 year- old woman came in with distal tight left main disease. We did a complex PCI that allowed her to live for six more fruitful years.
I feel that these are good examples that portray where we have been, how far we have come and where we are now.
Outside of medicine, what are your hobbies and interests?
Outside of medicine, I enjoy spending time with my family, going to the beach, travelling, wine tasting, and seeking out the next best invention.
2000–present Director of the Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
2009 Professor of Medicine (Cardiology), Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
2005–present David and Rose Orzen chair in Cardiology, Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
May 2011– April 2013 President, Israel Heart Society
1997–2000 Director of Interventional Cardiology and Cardiac Catheterization, Hadassah University Hospital, Jerusalem, Israel
Education and training
1987–89 Clinical and Research fellow in Nuclear Magnetic Resonance, Cardiovascular Division, University of Alabama at Birmingham, USA.
1984–87 Fellow in Cardiology, Hadassah University Medical Hospital, Jerusalem, Israel
1981–84 Residency program, Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
1980 Rotating internship, Hadassah Medical center, Jerusalem, Israel
1973–79 Hadassah Hebrew University Medical School, Jerusalem, Israel
Education in Cardiology Committee, European Society of Cardiology (2011–12)
Head of Electronic Education in Cardiology Committee, European Society of Cardiology (2012)
Fellow of the European Society of Cardiology (since 2004)
Fellow of the American College of Cardiology (since 1994)
Longstanding member of:
Israel Medical Association
Israel Heart Society
American Heart Association
Israel Society for the Prevention of Atherosclerosis
Israel Working Group for Interventional Cardiology
International Society for Heart Research, European Section, Israeli Subsection (Executive Board)
Medical Specializations Confirmation Committee of the Scientific Council of the Israeli Medical Association
SOS-CVD (Society of studying cardiovascular diseases)
2006 TCT Most Challenging Case in Operator Tutorial, Cardiovascular Research Foundation
2003 PCR Call for Cases Awards (3rd prize)
2003 CYPHER Stent Investigator Award, Cordis Johnson &Johnson Corporation