5 Questions with Dr. Bhatt

A Conversation With Emmanouil S. Brilakis, MD, PhD, FSCAI

Deepak L. Bhatt

For this issue, Dr. Bhatt talks with Cardiology Today’s Intervention Editorial Board Member Emmanouil S. Brilakis, MD, PhD, FSCAI, director of the Center for Complex Coronary Interventions at Minneapolis Heart Institute.

Brilakis received his medical degree from the National and Kapodistrian University of Athens in Greece. Next, he trained in internal medicine, cardiovascular diseases and interventional cardiology at Mayo Clinic in Minnesota. Thereafter, he completed his Masters in Clinical Research at Mayo Clinic and his PhD in Clinical Research at the National and Kapodistrian University of Athens. In 2004, Brilakis moved to Texas, where he served as director of the cardiac catheterization laboratories at VA North Texas Health Care System and was on the faculty of the University of Texas Southwestern Medical School until 2018, before assuming his current role at Minneapolis Heart Institute.

What are your hobbies outside of practicing medicine?

Emmanouil S. Brilakis

Dr. Brilakis: I enjoy exercise and try to exercise nearly every day — running, swimming, going to the gym. I also love music and help my children with their piano homework. I was actually an accordion teacher earlier in life. When I’m not working, I love spending time with my family and traveling with them.

What area of research in intervention most interests you right now, and why?

Dr. Brilakis: CTO intervention remains a key area of research for me. CTO PCI has matured over the last several years, but there are still new devices and techniques. There is a need for more studies on the clinical benefits of CTO PCI, how to use new equipment, and how to make the procedure more successful, efficient and safe.

Another area of interest is cardiogenic shock and hemodynamic support. Today, the confusion surrounding cardiogenic shock is monumental with lack of consensus on diagnosis and management. Advances in therapy, like reperfusion and mechanical support, have been associated with improvements in survival; however, mortality remains high and there is broad variation in outcomes. In 2018, SCAI organized SCAI SHOCK: A Team-Based Course on Cardiogenic Shock, which took place in Boston, to provide a comprehensive review of the diagnosis and management of cardiogenic shock. Today, if you’re going to be a state-of-the-art interventionalist, you have to understand and apply the basic concepts and devices for treating cardiogenic shock.

What advice would you offer a student in medical school today?

Dr. Brilakis: My No. 1 piece of advice is to strive for excellence. Second, it is important to develop and cultivate compassion early in your career. But compassion remains a key part and privilege of being a physician. My third piece of advice is don’t forget to be curious. There are so many things you’ll learn in medical school and advanced training. Keep an open mind and try to understand and simplify complexity. This will make your life and your medical career even more rewarding.

Have you ever been fortunate enough to witness or to have been part of medical history in the making?

Dr. Brilakis: Development of the CTO intervention area was medical history in the making for me, and I’m grateful to have been part of it. I started doing CTO interventions in the early 2000s, shortly after fellowship. It started by watching live cases at TCT and then I started doing them from scratch. I was fortunate to then meet expert CTO operators, from whom I learned a lot and who were instrumental in developing the hybrid algorithm for CTO PCI that is still used today. The last 10 to 12 years have been an amazing journey into this field that has matured from being outside the norm of standard interventional practice to a new subspecialty.

What’s up next for you?

Dr. Brilakis: We are working this year to finish a manual of a step-by-step approach to PCI that presents every step of each procedure and breaks it down on what can go wrong, potential challenges and what not to do in a very practical and easy-to-use way. We will have cases on YouTube linked to each section to help with understanding.

On the research side, we are running the SHINE-CTO study, a sham-controlled CTO trial. I am also excited about continued expansion of the PROGRESS-CTO registry, ASAP-SVG, a study of alirocumab (Praluent, Sanofi/Regeneron) to prevent progression of saphenous vein graft atherosclerosis and REBIRTH, a trial of transradial vs. transfemoral access in patients with non-STEMI.

The Cardiovascular Innovations (CVI) meeting is now in its third year in Denver and focuses on the practical aspects of interventional procedures in a highly interactive way with special emphasis on early career interventionalists and fellows. Finally, I am honored and excited to chair the SCAI 2020 meeting (Atlanta, May 2020), the go-to meeting for the practicing interventionalist in the U.S. and increasingly around the world. – by Katie Kalvaitis

Deepak L. Bhatt

For this issue, Dr. Bhatt talks with Cardiology Today’s Intervention Editorial Board Member Emmanouil S. Brilakis, MD, PhD, FSCAI, director of the Center for Complex Coronary Interventions at Minneapolis Heart Institute.

Brilakis received his medical degree from the National and Kapodistrian University of Athens in Greece. Next, he trained in internal medicine, cardiovascular diseases and interventional cardiology at Mayo Clinic in Minnesota. Thereafter, he completed his Masters in Clinical Research at Mayo Clinic and his PhD in Clinical Research at the National and Kapodistrian University of Athens. In 2004, Brilakis moved to Texas, where he served as director of the cardiac catheterization laboratories at VA North Texas Health Care System and was on the faculty of the University of Texas Southwestern Medical School until 2018, before assuming his current role at Minneapolis Heart Institute.

What are your hobbies outside of practicing medicine?

Emmanouil S. Brilakis

Dr. Brilakis: I enjoy exercise and try to exercise nearly every day — running, swimming, going to the gym. I also love music and help my children with their piano homework. I was actually an accordion teacher earlier in life. When I’m not working, I love spending time with my family and traveling with them.

What area of research in intervention most interests you right now, and why?

Dr. Brilakis: CTO intervention remains a key area of research for me. CTO PCI has matured over the last several years, but there are still new devices and techniques. There is a need for more studies on the clinical benefits of CTO PCI, how to use new equipment, and how to make the procedure more successful, efficient and safe.

Another area of interest is cardiogenic shock and hemodynamic support. Today, the confusion surrounding cardiogenic shock is monumental with lack of consensus on diagnosis and management. Advances in therapy, like reperfusion and mechanical support, have been associated with improvements in survival; however, mortality remains high and there is broad variation in outcomes. In 2018, SCAI organized SCAI SHOCK: A Team-Based Course on Cardiogenic Shock, which took place in Boston, to provide a comprehensive review of the diagnosis and management of cardiogenic shock. Today, if you’re going to be a state-of-the-art interventionalist, you have to understand and apply the basic concepts and devices for treating cardiogenic shock.

What advice would you offer a student in medical school today?

Dr. Brilakis: My No. 1 piece of advice is to strive for excellence. Second, it is important to develop and cultivate compassion early in your career. But compassion remains a key part and privilege of being a physician. My third piece of advice is don’t forget to be curious. There are so many things you’ll learn in medical school and advanced training. Keep an open mind and try to understand and simplify complexity. This will make your life and your medical career even more rewarding.

PAGE BREAK

Have you ever been fortunate enough to witness or to have been part of medical history in the making?

Dr. Brilakis: Development of the CTO intervention area was medical history in the making for me, and I’m grateful to have been part of it. I started doing CTO interventions in the early 2000s, shortly after fellowship. It started by watching live cases at TCT and then I started doing them from scratch. I was fortunate to then meet expert CTO operators, from whom I learned a lot and who were instrumental in developing the hybrid algorithm for CTO PCI that is still used today. The last 10 to 12 years have been an amazing journey into this field that has matured from being outside the norm of standard interventional practice to a new subspecialty.

What’s up next for you?

Dr. Brilakis: We are working this year to finish a manual of a step-by-step approach to PCI that presents every step of each procedure and breaks it down on what can go wrong, potential challenges and what not to do in a very practical and easy-to-use way. We will have cases on YouTube linked to each section to help with understanding.

On the research side, we are running the SHINE-CTO study, a sham-controlled CTO trial. I am also excited about continued expansion of the PROGRESS-CTO registry, ASAP-SVG, a study of alirocumab (Praluent, Sanofi/Regeneron) to prevent progression of saphenous vein graft atherosclerosis and REBIRTH, a trial of transradial vs. transfemoral access in patients with non-STEMI.

The Cardiovascular Innovations (CVI) meeting is now in its third year in Denver and focuses on the practical aspects of interventional procedures in a highly interactive way with special emphasis on early career interventionalists and fellows. Finally, I am honored and excited to chair the SCAI 2020 meeting (Atlanta, May 2020), the go-to meeting for the practicing interventionalist in the U.S. and increasingly around the world. – by Katie Kalvaitis