As a part of our “Meet Yale Internal Medicine” series, today’s feature is on Amit N. Vora, MD, MPH, assistant professor (cardiovascular medicine) and the Director of the Yale Transcatheter Mitral Valve Program.
As a resident, Amit N. Vora, MD, MPH, assistant professor of medicine (cardiovascular medicine), happened to have a rotation in the cardiology intensive care unit (CICU) at the time when the first clinical trials for transcatheter aortic valve replacement for severe aortic stenosis were beginning. He was able to care for some of the patients participating in the trials in the CICU, which is what first got him excited about a career in cardiology.
That excitement continued while he was a cardiology fellow at Duke, where he had additional exposure to new catheter-based approaches to treat older patients with severe aortic stenosis and other cardiac conditions.
“When these technologies were developed, they almost instantly changed the landscape for these patients. That’s when I decided to pursue a career in interventional cardiology,” says Vora. “It’s not often in medicine that you can immediately help patients feel better and live longer.”
Vora, who came to Yale in 2023 after five years as a structural interventional cardiologist at UPMC, is the director of the Transcatheter Mitral Valve Program, a new and growing program at Yale that uses minimally invasive procedures to treat patients with damaged or diseased mitral valves in the heart. Getting this program up and running has made it possible to treat patients who would otherwise have no other options, Vora says. “A dozen years ago, there weren’t good treatment options for these patients, who are generally in their 80s or 90s. Although traditional surgery is a great approach for the right patients, some patients may be too old and too sick to undergo traditional open-heart surgery. Now, most of our patients feel better right away and go home the day after their procedure.”
To help deliver care to more patients, the program recently opened a new hybrid catheterization lab/structural heart room, which offers a state-of-the-art facility to perform advanced structural heart procedures. Over the past several months, Vora and his colleagues have performed the first mitral repair in Connecticut using the Pascal device, the first BATMAN procedure, and their first commercial TriClip case, offering patients more access to innovative treatment options.
Vora is passionate about his work and wants to ensure that any patient who could benefit from therapy can access it. This includes many patients with mitral valve regurgitation, mitral valve stenosis, and severe aortic stenosis.
“Unfortunately, there is a lack of awareness and undertreatment of patients with these diagnoses nationally,” he says.
To help address undertreatment, he and his colleagues are working on implementing an artificial intelligence (AI) platform that will identify patients in the health system with severe aortic stenosis so that providers can offer them a timelier evaluation and treatment if necessary.
Vora says his move to Yale was prompted by his interest in expanding his responsibilities to include clinical research to continue to advance the field. “It’s a young field, and it’s rapidly progressing. But there’s much more we can learn,” he said. For example, he is currently working on research into new approaches to reduce the risk of stroke following a catheter procedure.
“There has been a lot of effort in developing and testing new technologies to reduce the risk of stroke from transcatheter aortic valve replacement (TAVR), but despite this, the risk of stroke from the procedure has remained stubbornly consistent at about two to four percent,” says Vora.
Alongside Alexandra Lansky, MD, professor of medicine (cardiovascular medicine) and national principal investigator for the PROTECT H2H (Protect the Head to Head) study, Vora is investigating if a new device called Emboliner could help prevent stroke. The device is made of a fine mesh that goes through the groin and covers the blood vessels that go to the brain.
“The hope is that by covering those blood vessels, any particles or calcium plaque debris that gets dislodged from the valve during a procedure will be captured and removed instead of traveling up towards the brain,” says Vora. He and his colleagues are currently enrolling patients in the trial.
He is also glad to have the opportunity to work closely with medical students, residents, and fellows as the program director of the Yale Advanced Fellowship in Structural Heart Disease. “Working with the fellows is fantastic. It’s great to watch them progress over the course of the year to the point where they can perform these procedures independently,” said Vora. “It’s a privilege to train the next generation of leaders. It’s amazing to think about how we can expand our impact in such a young field.”
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