Interviews with some of the U of M Advanced Heart Failure and Transplant Cardiologists.
Dr. Thennapan Thennapan
Can you tell us a bit about your background and what led you to specialize in advanced heart failure and transplant cardiology?
I received my medical training from the Tamil Nadu Dr. MGR Medial University, India. I then completed my residency training in Internal Medicine in 2005 at St. Francis Hospital with University of Illinois, Evanston, IL. Following this, I worked as a research fellow in the Center for Pulmonary Hypertension at the University of Chicago. Subsequently, I completed my fellowship training in Cardiovascular Medicine in 2012 and fellowship training in Advanced Heart failure and Transplant Cardiology in 2013 at the University of Chicago. I am a clinical research scholar interested in translational research in pulmonary vascular disease. During my fellowship training, I worked on redefining the epidemiology of pulmonary arterial hypertension in the current era.
Left heart failure is the most common cause of pulmonary hypertension. In addition, pulmonary hypertension leads to right heart failure. This led to my interest in advanced heart failure and transplant.
Do you have an area of focus within Advanced heart failure or transplant? If so, what?
Pulmonary Hypertension and Right Heart Failure.
What areas of research have you been involved in?
Better ways to prevent, diagnose, and treat high pressures in the lungs (pulmonary hypertension) that leads to failure of the right side of the heart. My current research focus is on developing novel therapies for right ventricular failure secondary to pulmonary vascular disease.
What is one thing that you wish more people knew about heart health and the treatment of advanced heart failure and transplant?
Prevention is better than cure.
What role do you see technology playing in the future of heart transplant and mechanical circulatory support care?
Xenotransplant is very exciting, and I see light at the end of the tunnel. This will revolutionize the field with unlimited supply of donor organs. I also believe that the artificial heart pumps we have now will become smaller and smarter in the future.
Outside of work, what are some of your personal interests or hobbies that you enjoy?
Outside work, I enjoy traveling and spending time with my family.
Finally, can you share a fun or interesting fact about yourself that might surprise your patients?
I love playing squash.
Dr. Jessica Schultz
Can you tell us a bit about your background and what led you to specialize in advanced heart failure and transplant cardiology?
I grew up in Chicago and am very close with my family there. I was in med school with the intent to becoming a surgeon, when my dad got critically ill with advanced heart failure, requiring first a HeartMate 2 LVAD, then a heart transplant during my third year of medical school. Seeing how amazing his team of doctors was, especially his advanced heart failure team, I knew that is what I wanted to dedicate my life to.
Do you have an area of focus within Advanced heart failure or transplant? If so, what?
My main area of research thus far has been in mechanical circulatory support devices and in particular LVADs.
What areas of research have you been involved in?
I have worked with Rebecca Cogswell on multiple LVAD projects from the University of Minnesota LVAD database to help advance the field in predicting and managing complications.
What is one thing that you wish more people knew about heart health and the treatment of advanced heart failure and transplant?
How subtle some of the warning signs can be. Some people’s main complaints are increasing fatigue, nausea, vomiting, and feeling full faster than usual. If more patients and non-heart failure providers have a higher clinical suspicion for it, we can start treatment sooner and hope to slow the progression to the advanced state.
What role do you see technology playing in the future of heart transplant and mechanical circulatory support care?
As mechanical circulatory support devices advance, there will be far fewer complications, they will last longer, and they will allow patients a chance for a more “normal” lifestyle than is currently available. Hopefully with new technology to preserve donor hearts, it will increase the donor availability. Also, with newer technology to detect both cellular and antibody mediated rejection faster, it will allow earlier treatment before there is any evidence of graft damage.
Outside of work, what are some of your personal interests or hobbies that you enjoy?
Spending time with my family. My perfect weekend is staying in and binge-watching my favorite shows and movies (I call it my bed-sore weekend).
Finally, can you share a fun or interesting fact about yourself that might surprise your patients?
I do not eat anything green (that includes fruits and veggies). You know the saying, “Do what I say, not what I do!”
Dr. Valmiki Maharaj
Can you share a bit about your background and what led you to specialize in advanced heart failure and transplant cardiology?
Though I originally was born in Dallas, Texas (and thus a diehard Cowboys fan!), I grew up in the Twin Cities and will remain here for the long haul. I had an early interest in anatomy and physiology from high school and college, which led to me attending medical school. Cardiology has a lot of math and physics as well, which I enjoy. Specializing in advanced heart failure allows me to utilize a variety of skills, and it is enjoyable to help the sick patients on life support, treat the acute decompensations, get people out of the ICU, and see them as follow-up in the clinic, able to live their lives. Maintaining that relationship is quite rewarding.
Do you have an area of focus within Advanced heart failure or transplant? If so, what?
I will certainly see any form of heart disease or congestive heart failure, leading towards advanced disease requiring heart transplantation and left ventricular assist devices. I am trying to build a presence for the University of Minnesota within cardiac amyloidosis, which is quite a prevalent undiagnosed condition.
What areas of research have you been involved in?
Research I have done includes outcomes for those requiring a heart transplant and left ventricular assist device, but also within quality improvement for treatment of congestive heart failure at the University and the Fairview Medical system. Amyloid projects are also in process.
What is one thing that you wish more people knew about heart health and the treatment of advanced heart failure and transplant?
Heart disease causes more morbidity and mortality than any other condition. I look at it similarly to how cancer is managed and treated. Patients may have an acute event, or chronic symptoms that are diagnosed as heart disease or congestive heart failure. Various blood tests, imaging tests, or procedures may be needed to manage, diagnose, or treat the condition. Typically, medical treatment requires multiple medications that each have their own role. The goal of treatment is to improve a patient's quantity and quality of life, diagnose the etiology of the heart disease to reverse the disease process, and improve the heart function. Patients may bring up concerns, or providers may see issues when patients feel well; it is about balance and, via shared decision making, choosing what is best for all parties involved.
What role do you see technology playing in the future of heart transplants and mechanical circulatory support care?
There will always be new innovations in medical and surgical treatment of heart failure. Whether it is incremental improvements in LVAD technology, donor heart management, or minimally invasive percutaneous procedures, technology and healthcare will continue to be intertwined for the future and I do not see that changing at all.
Outside of work, what are some of your personal interests or hobbies that you enjoy?
I have three young daughters aged 5 and under, so while they are the joy of my life, it is quite a handful. A day in the clinic can be less stressful than a day at home! I try to stay active through running and weightlifting. I am a huge football fan, both college, NFL, and fantasy football. When my wife and I do get out, we are big foodies and always looking to try the new place in town.
Can you describe your motivation to be a source of support for patients both before and after transplant/LVAD?
Being diagnosed with congestive heart failure, advanced heart failure, looking at transplant and LVAD, are all stressful conditions. The connection between our heart health and mental health is well known. This is a long journey that is difficult to get through on your own; it takes a village. The providers at the University of Minnesota will always be happy to be part of that village for patients.
Finally, can you share a fun or interesting fact about yourself that might surprise your patients?
Prior to having children, my wife and I hiked up Mount Kilimanjaro, the highest free-standing mountain above sea level. It took about 6 days of hiking and camping, but that last day was the most exhilarating and exhausting thing I have ever done. That last trek up, every two steps I took I just looked for a rock to lean on!
Dr. Tamas Alexy
Can you share a bit about your background and what led you to specialize in advanced heart failure and transplant cardiology?
I was born in a city located in the Southern part of Hungary, called Pecs. Both of my parents were physicians, and I knew from early on that I would like to follow in their footsteps. Even though my father was a pulmonologist, and my mother was a nephrologist, I was always fascinated by the heart and became interested in cardiology.
After finishing medical school, I decided to stay at the University of Pecs and started my PhD in clinical cardiology. It was during this time that I received a one-year scholarship to visit one of the leading labs in the field at USC in Los Angeles, CA. As the year was coming to an end, I was offered the tremendous opportunity to extend my stay and to complete my PhD thesis at USC. While I enjoyed my research work, I also realized how much I am missing clinical patient care so after a few years I decided that I should combine these.
To practice medicine in the US, however, I had to take all medical school exams (USMLE) first. Dr. Brown from the University of Minnesota gave me the opportunity to complete my internship and residency training at the University of Minnesota. I always relished the notoriously busy “Cards2 service” and loved seeing how the sickest patients on death’s door walked out of the hospital resuming a “normal” life. While on this service, I was fascinated how significant a difference we were able to make in our patient’s lives. Patients, who were often considered “family” given the long-standing relationship with their physicians and care team. I was also fascinated by the hemodynamics, and enjoyed the teaching by the inspirational attendings, especially Dr. Cindy Martin, who always served as my mentor and role model.
I knew at that time that I would like to continue caring for patients with advanced heart failure. After residency I continued my training at one of the premier Institutions for heart care, Emory University in Atlanta, where I completed my cardiology and advanced heart failure fellowships. Subsequently, I was given the privilege to return to Minnesota and to join a wonderful team.
Do you have an area of focus within Advanced heart failure or transplant? If so, what?
Within the field of advanced hear failure my passions remain heart transplant as well as simultaneous heart/kidney transplant with the goal to improve survival and quality of life for all patients. I spend a lot of time ensuring that management is optimal in the pre- as well as in the post-operative period as these are critical to achieve and maintain good outcomes. I am also involved in trials with new methodologies aiming to reduce invasive procedures after heart transplantation. I also love the cardiac catheterization laboratory as the “table of truth” helps me understand and appreciate hemodynamics.
What areas of research have you been involved in?
During my PhD, my research focused primarily on the flow properties of blood. During my residency, cardiology fellowship, and since starting my job at the “U”, I have been focusing primarily on clinical outcomes and survival of transplant recipients including heart alone and simultaneous heart/kidney. In addition, since working with UNOS for the past couple of years, I have been looking at ways to streamline the heart allocation policy, increase organ availability, and make the process more efficient for everyone.
What is one thing that you wish more people knew about heart health and the treatment of advanced heart failure and transplant?
Many people tend to minimize or ignore problems and health-related issues, subtle warning signs. Organs do require some care and “maintenance”. Some major issues may be prevented with routine, preemptive care and a heart healthy lifestyle. It is important that people recognize and act on warning signs and discuss these with their provider. We often meet patients way too late when their heart disease cannot be reversed anymore, and advanced therapies remain the only option.
What role do you see technology playing in the future of heart transplants and mechanical circulatory support care?
Technology has advanced exponentially over the past couple of years. Temporary mechanical circulatory support devices have become more advanced and are able to provide longer-term support safer, and with better outcomes. For some, these may be used to achieve heart recovery. The development and clinical introduction of the HeartMate III LVAD was a game changer in advanced heart failure care. Patients supported with this device experience significantly fewer complications such as stroke and pump clotting. They have a dramatically better quality of life. On the transplant front, we have introduced new procurement options such as “DCD” (donation after circulatory death), we are able to transport beating hearts from longer distances using the Organ Care System (OCS – “the box”), accept precious organs from hepatitis C positive donors, and our program has transplanted several candidates directly from VA-ECMO (heart-lung machine). Many of these were not possible even a few years ago. It will be very interesting to see where the technology will take us over the next decade.
Outside of work, what are some of your personal interests or hobbies that you enjoy?
I love spending time with my family, traveling to explore the World and new countries. Always open to meet up with friends. I spend a lot of time in front of the computer and try to “sneak in” some simulator time, especially flight simulator, in the middle of the night. I used to be a soccer fan but, admittedly, this is an interest that proved to be harder to maintain in the US.
You have been very supportive of Second Chance for Life, presenting at our educational event in May and attending our Holiday party last December. Can you describe your motivation to be a source of support for patients both before and after transplant/LVAD?
I love spending time with our patients and their families, listen to their journeys, and learn from their experience. I meet with many of you in the hospital setting, either when needing admission, or in the cath lab for a procedure. It is fulfilling to see everyone outside of these settings. I love watching how everyone comes together like an extended family, provides support for each other, and forms new friendships. LVAD and transplant recipients are a very unique group of individuals who share a scary and very unique journey.
Finally, can you share a fun or interesting fact about yourself that might surprise your patients?
Many of you know that I am not sleeping too much during the week and strive on caffeine, like multiple triple espressos, energy drinks. Yet I don’t have any issues like difficulty falling asleep, hand tremor, or palpitations. I did, however, a long time ago while in medical school, have an episode of a-fib unrelated to caffeine intake. It was quite scarry but as a good and responsible student, I self-treated myself with my grandmother’s metoprolol. I had no recurrence, but I will probably consider alternative options (like reducing caffeine 😊)