5 Questions

Anita W. Asgar, MD, MSc, navigates paradigm shifts in transcatheter valve therapy

For this issue, Cardiology Today spoke with Editorial Board Member Anita W. Asgar, MD, MSc, FRCPC, FACC, director of transcatheter valve therapy research at Institute Cardiologie de Montréal, Université de Montréal and governor-elect for the Quebec chapter of the American College of Cardiology.

Asgar received her medical degree from and completed her internal medicine residency at Memorial University in St. John’s, Newfoundland and Labrador, Canada. She completed a cardiology fellowship at Dalhousie University in Halifax, Nova Scotia, Canada, in 2004, then an interventional cardiology fellowship at the Institute Cardiologie de Montréal in 2006, after which she crossed the Atlantic Ocean to complete fellowships in structural and congenital intervention and cardiac MRI at Royal Brompton Hospital in London. She returned to the Institute Cardiologie de Montréal in 2009 and has worked there ever since.

Asgar has been involved with transcatheter valve procedures since their introduction into North America, witnessing one of the first transcatheter aortic valve replacements in North America and beginning Quebec’s first transcatheter mitral valve leaflet repair program in 2010. She received a Young Leadership Recognition Award from Cardiovascular Research Technologies in 2010 and 2016. Asgar is associate editor of the Structural & Valvular Clinical Interest Section at the Society for Cardiovascular Angiography and Interventions and was selected by the society as an Emerging Leader in 2013. She co-chaired the writing group of the Canadian Cardiovascular Society’s position statement on TAVR and has published papers on a variety of structural and congenital heart disease topics.

Who has had the greatest influence on your career?

Dr. Asgar: The first answer does not necessarily concern people, but places. I did my cardiology fellowship at Institute Cardiologie de Montréal and Royal Brompton Hospital. This was in the mid-2000s, when TAVR and transcatheter mitral valve repair (TMVR) were just getting started. These stints made me realize how much cardiology was changing and how much was possible. Getting the opportunity to see all that influenced my career and the direction it ended up taking.

Anita W. Asgar

I would also say Michael Mullen, MD, consultant cardiologist and director of the cath lab at Royal Brompton, who was my mentor when I was there. He had an amazing approach to patients and procedures. He gave me the best advice I ever got in my career, which is that sometimes in life, you get to reinvent yourself, perhaps every 5 years, and reconnect with what you want to be doing. I keep this in mind when I am asked for advice. I tell people to find something that they are interested in regardless of what their job prospects might be. Find something they are really passionate about and interested in learning about, and pursue that. Things change over time, and where one ends up may not be where one expected to be. It may be somewhere better.

What has been the greatest challenge in your professional career thus far?

Dr. Asgar: It’s a combination of trying to balance your career and your personal life, and still show up to do your best at both. That is what I find the most challenging, because our lives are so busy. There is a huge commitment from traveling to conferences, taking care of patients and planning procedure, and then leaving meaningful time for family.

What areas of research in cardiology interest you most right now?

Dr. Asgar: Transcatheter valve therapy, including treatments of aortic stenosis, mitral regurgitation and tricuspid regurgitation. We are beginning to understand how, with this new technology, there is a paradigm shift in how we treat these diseases. For aortic stenosis, one always had to weigh the risks and benefits of surgery when deciding whether to treat a patient who is asymptomatic because there are potentially significant complications from surgery. We would tend to wait. Now that we have technology that allows us to do less invasive procedures with relatively low morbidity, we can perhaps expand that treatment paradigm to start treating patients even before their condition starts becoming potentially severe. For example, treating moderate mitral regurgitation. We are trying to understand if treating these patients with technologies like MitraClip (Abbott) earlier prevents complications and enables a patient to leave the hospital the next day. We may be changing our approaches to valvular heart disease completely now that we have these new technologies available. This is an area of great interest at the present time.

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

Dr. Asgar: I was a fellow at Institute Cardiologie de Montréal in 2006 when the first North American TAVR procedure with a self-expanding valve (CoreValve, Medtronic) was performed. As a fellow, I did not perform the procedure, but I was in the room and I was the person taking pictures. To be able to see something like that changed the way I thought about interventional cardiology and what its future might be. I started my career at a time when TAVR and TMVR were becoming realistic options. I was very lucky to see a lot of that and was one of the first to perform a transseptal TMVR. That probably explains why this is my greatest area of interest.

What was the defining moment that led you to your field?

Dr. Asgar: Like many people who end up in cardiology, I was touched by heart disease when I was young. My father had an MI when I was several months old. I grew up with a father who suffered from angina and then HF. I watched him go through all the stages that patients with HF experience: cardiac resynchronization therapy, a defibrillator, etc. Watching him suffer through that and spending time in the hospital with him made me think that this was something I wanted to do. I felt like I could understand what it was like to be a patient in that scenario, and I wanted to make a difference there. – by Erik Swain

For this issue, Cardiology Today spoke with Editorial Board Member Anita W. Asgar, MD, MSc, FRCPC, FACC, director of transcatheter valve therapy research at Institute Cardiologie de Montréal, Université de Montréal and governor-elect for the Quebec chapter of the American College of Cardiology.

Asgar received her medical degree from and completed her internal medicine residency at Memorial University in St. John’s, Newfoundland and Labrador, Canada. She completed a cardiology fellowship at Dalhousie University in Halifax, Nova Scotia, Canada, in 2004, then an interventional cardiology fellowship at the Institute Cardiologie de Montréal in 2006, after which she crossed the Atlantic Ocean to complete fellowships in structural and congenital intervention and cardiac MRI at Royal Brompton Hospital in London. She returned to the Institute Cardiologie de Montréal in 2009 and has worked there ever since.

Asgar has been involved with transcatheter valve procedures since their introduction into North America, witnessing one of the first transcatheter aortic valve replacements in North America and beginning Quebec’s first transcatheter mitral valve leaflet repair program in 2010. She received a Young Leadership Recognition Award from Cardiovascular Research Technologies in 2010 and 2016. Asgar is associate editor of the Structural & Valvular Clinical Interest Section at the Society for Cardiovascular Angiography and Interventions and was selected by the society as an Emerging Leader in 2013. She co-chaired the writing group of the Canadian Cardiovascular Society’s position statement on TAVR and has published papers on a variety of structural and congenital heart disease topics.

Who has had the greatest influence on your career?

Dr. Asgar: The first answer does not necessarily concern people, but places. I did my cardiology fellowship at Institute Cardiologie de Montréal and Royal Brompton Hospital. This was in the mid-2000s, when TAVR and transcatheter mitral valve repair (TMVR) were just getting started. These stints made me realize how much cardiology was changing and how much was possible. Getting the opportunity to see all that influenced my career and the direction it ended up taking.

Anita W. Asgar

I would also say Michael Mullen, MD, consultant cardiologist and director of the cath lab at Royal Brompton, who was my mentor when I was there. He had an amazing approach to patients and procedures. He gave me the best advice I ever got in my career, which is that sometimes in life, you get to reinvent yourself, perhaps every 5 years, and reconnect with what you want to be doing. I keep this in mind when I am asked for advice. I tell people to find something that they are interested in regardless of what their job prospects might be. Find something they are really passionate about and interested in learning about, and pursue that. Things change over time, and where one ends up may not be where one expected to be. It may be somewhere better.

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What has been the greatest challenge in your professional career thus far?

Dr. Asgar: It’s a combination of trying to balance your career and your personal life, and still show up to do your best at both. That is what I find the most challenging, because our lives are so busy. There is a huge commitment from traveling to conferences, taking care of patients and planning procedure, and then leaving meaningful time for family.

What areas of research in cardiology interest you most right now?

Dr. Asgar: Transcatheter valve therapy, including treatments of aortic stenosis, mitral regurgitation and tricuspid regurgitation. We are beginning to understand how, with this new technology, there is a paradigm shift in how we treat these diseases. For aortic stenosis, one always had to weigh the risks and benefits of surgery when deciding whether to treat a patient who is asymptomatic because there are potentially significant complications from surgery. We would tend to wait. Now that we have technology that allows us to do less invasive procedures with relatively low morbidity, we can perhaps expand that treatment paradigm to start treating patients even before their condition starts becoming potentially severe. For example, treating moderate mitral regurgitation. We are trying to understand if treating these patients with technologies like MitraClip (Abbott) earlier prevents complications and enables a patient to leave the hospital the next day. We may be changing our approaches to valvular heart disease completely now that we have these new technologies available. This is an area of great interest at the present time.

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

Dr. Asgar: I was a fellow at Institute Cardiologie de Montréal in 2006 when the first North American TAVR procedure with a self-expanding valve (CoreValve, Medtronic) was performed. As a fellow, I did not perform the procedure, but I was in the room and I was the person taking pictures. To be able to see something like that changed the way I thought about interventional cardiology and what its future might be. I started my career at a time when TAVR and TMVR were becoming realistic options. I was very lucky to see a lot of that and was one of the first to perform a transseptal TMVR. That probably explains why this is my greatest area of interest.

What was the defining moment that led you to your field?

Dr. Asgar: Like many people who end up in cardiology, I was touched by heart disease when I was young. My father had an MI when I was several months old. I grew up with a father who suffered from angina and then HF. I watched him go through all the stages that patients with HF experience: cardiac resynchronization therapy, a defibrillator, etc. Watching him suffer through that and spending time in the hospital with him made me think that this was something I wanted to do. I felt like I could understand what it was like to be a patient in that scenario, and I wanted to make a difference there. – by Erik Swain