Puneet Gandotra, MD: The Trends of Treatment

FEBRUARY 04, 2018
Matt Hoffman
Puneet Gandotra, MD, the director of the Cardiac Catheterization Lab at Southside Hospital spoke with MD Magazine about the needs of interventional cardiology. These physicians are keeping their eyes on many products in the pipeline that are seeking to provide better imaging techniques for chronic total occlusions, and wider availability of repositionable and re-deployable heart valves.


Puneet Gandotra, MD, the director of the Cardiac Catheterization Lab at Southside Hospital:
Looking at coronaries—when we look at chronic total occlusions, [which are] probably the most challenging thing an interventional cardiologist does, for me what I'm looking at is: I need a better visual or a better imaging technique to provide me with a pathway of where I'm headed.

When a blockage is 100%, you may not find the channel. You may end up in non-channel areas, and that's where, I think, I'm looking forward to better imaging techniques. I'm really noticing and seeing companies investing a lot of money in trying to find us better tools for treatment of these patients.

The other trends of a treatment are mostly for heart valves and we're seeing a lot of new technology coming through valves that are repositionable, meaning even after you deploy most of the heart valve, if you do not appreciate or like the way that it's being deployed, you can actually pull it back and then redeploy. That's something—some of the valves already have it, but not to the degree where we would like it, and I think that's one of the new pipeline products by multiple companies—I think Medtronic, and St. Jude, and Edwards, are all looking to find ways—and Boston Scientific—you know, every company has their own pipeline product which is very exciting to really look at.

I think a lot of new pipeline products for pulmonary embolism treatment—not traditionally a cardiology world—but I think because it's a catheter-based technique, cardiologists are going to get involved. We are looking at different companies where they are actually proceeding with finding catheters that are large, suction-based catheters where you don't have to necessarily do any type of open-heart surgery to go in and try to take out the clot.

This is one mechanism we're using going from the leg going up to the heart and trying to suction out clot. It is a great mechanism, and companies like Penumbra, companies like Inari Medical, multiple companies are really watching how they're developing their products. A lot of these products develop, actually, from stroke interventions, and now towards the heart, as well.

Speaking about trends regarding stroke intervention—and that's something I think that even though cardiologists have not been traditionally involved in, I think we have the infrastructure for involvement because we have the call schedules, we have the catheter skills, we have the wire skills, and I think getting involved in stroke and acute stroke interventions is very exciting. That's something that, personally, I'm very interested in for the future in the next 5 to 10 years.

At least 3 major studies in the past 2 years have shown that the traditional mechanism of giving full dose TPA, or clot-busting medication, may not necessarily be the best mechanism. Maybe we can do something, maybe we can do better, maybe we can actually go in and suck out that clot that actually is causing that stroke. That's something that I'm really, truly watching at this point and hopefully, there will be some mechanism of us getting involved as well.

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