Focus on K2P Faculty: Dr. John Vavalle
John P. Vavalle, MD, MHS, FACC serves as faculty for K2P’s CurrentMD Cardiology, where he has provided several activities and case studies on the diagnosis and management of aortic stenosis and mitral regurgitation.
Dr. Vavalle is an interventional cardiologist and an Associate Professor of Medicine in the Division of Cardiology at the University of North Carolina. He is also the Medical Director of the UNC Structural Heart Disease Program and the Program Director of the Structural Heart Disease Fellowship and the Associate Program Director of the Interventional Cardiovascular Fellowship Program at UNC School of Medicine.
Dr. Vavalle’s main areas of interest are in percutaneous structural and valvular heart disease interventions, as well as coronary interventions. With the rapid evolution in the fields of interventional cardiology and cardiac surgery, Dr. Vavalle focuses on increasing partnerships between the fields of interventional cardiology and cardiac surgery to create a seamless program where the two specialties work together to perform hybrid and minimally-invasive procedures. Dr. Vavalle also offers procedural expertise in complex coronary interventions, transcatheter closure of paravalvular leaks, repair of congenital cardiac defects, and closure of coronary fistulas.
We sat down with Dr. Vavalle to ask a few questions…
What would you like learners to take from your talks on valvular heart disease?
It’s my hope that after reviewing these modules on valvular heart disease, learners feel more comfortable managing patients with aortic and mitral valve disease, and they feel more familiar with the current guidelines and more comfortable knowing when to send patients for interventions, either percutaneous or surgery. I think it’s important that our learners, when they see patients with valvular heart disease, have the confidence to know that they are appropriately managing their patients and know when to refer to proceduralists or cardiac surgeons for definitive intervention.
What do you think has been the greatest advance in valvular heart disease over the last five to 10 years?
That’s an easy question to answer. The single biggest advance in the treatment of valvular heart disease over the last five to 10 years has been the advent of percutaneous therapies – transcatheter valve replacement, and transcatheter mitral valve repair. And pretty soon we will have the technology for transcatheter mitral valve replacement, transcatheter tricuspid valve repair, and transcatheter tricuspid valve replacement. We already have the technology for transcatheter pulmonic valve replacement. So, in essence, the ability to replace and repair valves without open heart surgery has been a tremendous leap forward in the field of cardiovascular medicine. It’s probably the single biggest advance I will see in my career.
The answer to this question might be similar, but where do you think we’re going to be in the treatment of valvular disease 10 years from now?
The field of structural heart disease interventions will only continue to evolve, and I think the pace at which we evolve will only accelerate in the years ahead. It’s hard to predict where we’ll be exactly in five or 10 years, but what I know for certain is that we will have better technology and better awareness of percutaneous therapies for valvular heart disease, and we will have new devices that will allow us to both repair and replace valves without open heart surgery. As we evolve as a community, as we get better with imaging and patient selection, and the technology continues to advance, I think this will be the standard of care for the vast majority of patients with valvular heart disease, not just the aortic valve stenosis, but mitral valve regurgitation, tricuspid valve regurgitation. I think the overwhelming majority of patients in the future with valvular heart disease who need interventions will be treated with transcatheter percutaneous therapies.
You mentioned timely referral and I know that is something that the general cardiology field needs to be very aware of. Do you have any best practices for the referral of patients to a valve center or a valve specialist?
Reach out early and reach out often. I think the key is to have a good working relationship with your valve center and the valvular disease specialists. Don’t be shy about curb-siding your valvular heart disease specialists, or asking them to review an echocardiogram. The thing we hate to see most are patients who were sent too late, where we’ve missed that window of opportunity to intervene. They are too sick, too frail, or their ventricular function is too poor. We’d much prefer to see the patient before they actually need an intervention. We can work with the local cardiologist or primary care physician to set up a surveillance plan where every six or 12 months they come back for an echocardiogram and symptom surveillance. That’s a much better position to be in than to receive the patients on the back end when the damage is done and it’s too late.
What career would you have chosen if you hadn’t chosen to become a physician?
If I hadn’t chosen to be a physician, I would probably be a high school chemistry teacher. I’ve always loved chemistry. I was a chemistry major for the longest time. I thought I was going to be a chemist. And I also really love teaching. That’s part of the reason why I’m at an academic medical center. And in fact, I still may do it. Sometimes I tell my wife that I may retire early and go teach chemistry at the local high school because I still have the desire to do that.
How has your career been different than you expected?
When I started training in cardiology, TAVR was still this very novel idea that was just beginning in clinical trials, and most people didn’t think it was really going to work. And if it did work, we thought it would really just be reserved for the frailest patients who just couldn’t have surgery. It was going to be a Hail Mary kind of procedure for a select few patients.
What is an interesting fact about you?
I love to cook. I cook a lot. I cook too much. I cook too often. I always have a refrigerator full of leftovers. It’s what I like to do in my spare time.
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