Ron Waksman (MedStar Heart & Vascular Institute, Washington, DC, USA) is the course chairman of Cardiovascular Research Technologies (CRT; 3–6 March, Washington, DC, USA), which this year had Barack Obama as its keynote speaker. Waksman talks to Cardiovascular News about the insights that former US presidents can provide, his career achievements, and what makes CRT unique.
Why did you decide go into medicine and why, in particular, interventional cardiology?
When I was doing military service, I witnessed situations in which some of the soldiers were badly injured; I wanted the capability to treat them and that experience motivated me to go into medicine.
I have always believed that innovation is the key to furthering the field of medicine; therefore, I decided to become an interventional cardiology intern because innovation is an important part of that field.
Who have been your career mentors?
My mentor was Spencer B King, who is one of the founders of interventional cardiology; he actually brought Andreas Grüntzig from Zurich to work at Emory University (where King worked). I feel privileged that many years after this, he offered me a position as an interventional cardiology fellow at Emory.
What has been the most important development in interventional cardiology during your career?
I have been practising interventional cardiology for the past 25 years and during that time, the introduction of stents has definitely been the most important development. That said while they solved a lot of problems, they also created a lot of problems. For example, restenosis.
I believe that my main contribution to the field of interventional cardiology has been designing and developing brachytherapy—using local radiation therapy to treat restenosis.
While I was working at Emory, we designed a clinical trial that enabled brachytherapy to get a stage to which it could be licensed by a company. This company then put it through the regulatory approval. At the time, brachytherapy was the best solution for patients who had restenosis with metallic stents. Twenty years later, it is still used for some patients who have restenosis after receiving a drug-eluting stent.
Another important development that has occurred during my career has been the introduction of transcatheter aortic valve implantation (TAVI). Transcatheter therapies are not ending there; we are now hearing about such therapies for the tricuspid and mitral valves.
What are your current research interests?
At present, my main interest is developing a bioresorbable metallic scaffold—Magmaris (Biotronik). I have been working on this for the past 11 years, and I am actively involved in shaping and improving this technology.
I think there are important differences between this scaffold and the polymerisation of L,L-lactide (PLLA) scaffold (Absorb, Abbott). Studies have indicated that device thrombosis with Magmaris are comparable to that of a current-generation drug-eluting stent; therefore, I do not think device thrombosis will be the issue with this device that it was for the PLLA scaffold.
You are the director of CRT. What makes the meeting unique?
I started CRT 21 years ago. I think people like it because they can listen to a range of topics that will advance their knowledge. Overall, we cover five tracks—from coronary to atherosclerosis and research—and each one is relevant for interventional cardiologists.
Also, we have an impressive faculty list—this year, we had more than 500 faculty members. Additionally, this year, the meeting was very large as we had 3,139 attendees.
Your belief in the importance of innovation prompted you to go into interventional cardiology. In what ways does CRT support innovation?
We encouraged innovation in several ways. For example, we had a “Technology & Innovation” track and we had an innovations competition. For me, innovation does not have to be a device as it can be an improved technique as well as a novel device.
I think the younger generation of interventional cardiologists are committed to improving techniques. They want to make things better for patients.
What were the highlights of this year’s meeting?
No doubt that the highlight of this year’s meeting was the first-ever live case to be performed by a female-only team of interventional cardiologists, moderated solely by female interventional cardiologists. The case sparked enthusiasm and helped to close the gender gap in the field of interventional cardiology.
The late breaking trials on low-risk TAVI and the new “M” valve for the mitral position were among 12 late-breaking trials that were presented at the meeting. The best innovation was awarded to the 4C technology for mitral valve replacement. Finally the keynote event with President Barack Obama was outstanding and enthused the attendees of the meeting. For CRT, he was the third living president at the meeting. It was the most attended event.
Why did you ask Obama to speak at the meeting?
A few years ago, because CRT takes place in Washington, DC, I decided to start making the keynote speaker a well-known figure from Washington. Therefore, Obama is not the first past US president we have had at CRT. Before that, we have had Clinton and we have had Bush (George W). We also have had people who have run for the presidency. For example, Mitt Romney and Al Gore.
So, we do try to bring true leaders in US politics to learn from them. Obviously, they do not talk about medicine, but they talk about leadership.
We feel having keynote speakers such as these is an opportunity to educate and provide value to the delegates attending CRT.
Getting Obama to speak was exciting because he has just finished his time as president. He is still based in Washington, DC, so it was a good opportunity. The interview was in the form of a Q&A and we reviewed his journey from his childhood in Hawaii (where he lived with grandparents) to becoming the first African American president. We also discussed the challenges of bringing up daughters in the White House and, of course, what his greatest accomplishments and regrets were during his presidency.
Will you be asking the current incumbent of the White House to speak at CRT after his term finishes?
I do not ask individuals when they are actively in position but when he is done with his term, I would love to see him as a keynote speaker! So far we have had three US living presidents as keynote speakers at CRT—obviously we would love to have the fourth one as well!
I think CRT is unique; there is not a meeting like it in the entire world in terms of the keynote speakers that we have. Being based in Washington, DC, we have a lot of connections.
What was your most memorable case?
There is no specific case that I can refer to. During my career I have engaged in thousands of cases many of them complex and heroic. But, whenever I have an opportunity to perform a procedure with a new technology or technique, I feel the thrill of the opportunity that has been given to me in being part of this exciting and rewarding field.
What advice would you give to someone just coming into the profession?
I would say, firstly that they should ask questions. Secondly, if they do not have a passion for interventional cardiology, then they are in the wrong field.
Thirdly, one of the biggest things today is networking via social media, which was not around when I was in med school, and online information. So, they need to be engaged with that.
Fourthly, even if they do not want to get involved with academic writing or research, they need to be keep on top of new data that are coming out.
Ultimately, people coming into the profession need to know that they do not have to accept something as the status quo just because that might be what they have been taught.
What was your childhood dream job?
I wanted to go to the moon; I want to be an astronaut—I wanted to be a pilot and fly directly to the moon. I found the first moon landing (1969) very inspiring!
Outside of medicine, what are your hobbies and interests?
Before the era of the internet, I was interested in making and using transistor radios—you could use them to communicate with the rest of the world. Obviously, you do not use them anymore as there are other means of communication.
Another interest is films—they take you into a whole other world of imagination. You can dream about a whole different life. I found The Shape of Water, directed by Guillermo del Toro, very inspiring. Films give you the licence to use your imagination.
- Director, Cardiovascular Research and Advanced Education, MedStar Heart & Vascular Institute, Washington, DC, USA
- Professor of Medicine, Georgetown University, Washington, DC, USA
- Associate Director, Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Course chairman, CRT
- 2001–2012: Director, Cardiovascular Research and Advanced Education, MedStar Heart & Vascular Institute, Washington, DC, USA
- 1997–2001: Associate professor of Medicine Georgetown University, Washington, DC. USA
- 1999–2001: Director, Experimental Angioplasty & New Technologies, Cardiovascular Research Institute
- 1995–1996: Fellowship, Interventional Cardiology, Emory University, Atlanta, USA
- 1992–1995: Fellowship, Cardiology, Emory University, Atlanta, USA
- 1988–1991: Residency, Cardiology, Ein Kerem Hospital, Jerusalem, Israel
- 1983–1988: Residency, Internal Medicine, Mt Scopus Hospital, Jerusalem, Israel
- 1981–1982: Internship, Hillel Yaffe Hospital, Hadera, Israel
- 1981:Medical School Ben Gurion University, Beer-Sheva, Israel
- Editor-in-chief, Cardiovascular Revascularization Medicine
- Section editor, Journal of Interventional Cardiology
- Current Editorial Board, Catheterization and Cardiovascular
- Editorial board, Structural Heart Journal
- Editorial board, European Heart Journal
- Editorial consultant, JACC Cardiovascular Interventions
- Editorial board, Future Cardiology
- Editorial Board, Journal of the American College of Cardiology
- Editorial Board, Journal of Invasive Cardiology