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Interview Profile Chaim Lotan
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 dur- ing my cardiology internship when the Prime Minister of Israel at that time was hospitalised in the unit follow- ing 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. Hadas- sah 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 fas- cinating 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 fail- ure 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 fascinat- ing 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 sys- tem (InspireMD), a unique mesh-covered stent designed to prevent distal embolisation. I truly believe this tech- nology 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 termi- nated early due to safety concerns over adverse observa- tions 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 percutane- ous coronary intervention (PCI) in diabetic patients with multivessel disease
b) FAME II has shown the importance of frac- tional flow reserve in intermediate/question- able 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 technol- ogy 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
August 2013
technologies on current and future therapy, and clinical overviews on specific topics with an empha- sis on future perspec- tives presented by lead- ing international experts. The popular “Technology Parade” offers biomedical technology start-ups from around the world the op- portunity to present their latest developments. A recent add-on to the meeting is the prestigious “ICI Start-up of the Year” competi- tion.
ICI is dedicated to the innova- tions in the cardiovascular world, and we have added a new track session to the programme called “Connected Health”. This excit- ing new topic covers the ex- panding world of digital health,
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