Share ThisIn our Ask a Doc series, we sit down with physicians and other clinical experts, including those at Allegheny Health Network (AHN), for a chat on an important health topic. In this interview, we talk with Dr. Adnan Khalif, a cardiologist at the AHN Cardiovascular Institute, about interventional cardiology.
Interventional cardiology is a medical specialty that provides minimally invasive and non-surgical treatment options for parts of the heart that are affected by disease processes.
To learn more about this topic, I spoke with Adnan Khalif, MD, interventional cardiologist and critical care cardiologist with the AHN Cardiovascular Institute.
Megha Pai: What inspired you to specialize in interventional cardiology, and what do you find most rewarding about your work as an interventional cardiologist?
Dr. Adnan Khalif: For me, it was the ability to instantly achieve symptom improvement — the immediate satisfaction that a patient's life will be positively affected by a minimally invasive procedure. Increasing the lifespan of a patient in front of your eyes is deeply rewarding, and the ability to make that impact through minimally invasive procedures was hard to pass up — such as using a small catheter to remove a life-threatening clot from a patient's lungs. The work we do is really impactful for patients, and that's rewarding for me.
Megha Pai: What advice would you give to someone who is considering a career in interventional cardiology?
Dr. Adnan Khalif: Somebody who is considering this career might be someone who's eager to facilitate evidence-based practices to improve patient outcomes, from improvement in symptoms to increasing the survival and longevity of patients — and achieve that through minimally invasive options. Advice I'd give that person would be to get in touch with someone in this space who is doing interventional cardiology; reach out and identify mentors that they can discuss the field with, including what career paths they could take. I think it's such a rewarding specialty to be in.
Megha Pai: Can you explain at a high level what interventional cardiology is?
Dr. Adnan Khalif: Interventional cardiology is the treatment of conditions that affect the heart and blood vessels that make up the circulatory system. Interventional cardiology is a sub-specialty of cardiology that provides minimally invasive procedures and non-surgical options to patients by using flexible tubes, catheters that repair damaged vessels and narrow arteries, as well as other structures of the heart, including heart valves.
Megha Pai: What conditions do patients have that require interventional cardiology?
Dr. Adnan Khalif: The most common condition we treat is coronary artery disease. We also treat patients who have valvular heart disease, or structural heart abnormalities with their valves. More recently we've been treating patients with peripheral vascular disease, as well as patients with atrial fibrillation. Sometimes, adult patients with congenital heart disease seek our care, too.
Megha Pai: How does AHN's approach to interventional cardiology, and cardiovascular care in general, help patients feel at ease with their conditions?
Dr. Adnan Khalif: I love that we offer a multidisciplinary approach, which we call the heart team approach. It's an approach that includes the interventional cardiologists, the patient's general cardiologist or primary care providers, cardiac surgeons and specialists like the advanced heart failure team. Bringing together multiple disciplines, we're able to create a patient-centered approach to offer the best care for each specific patient. We typically present our patients in a multidisciplinary fashion at a meeting and go over all the data for each patient — whether that be imaging data, clinical data, age, geographic information, etc. We look at all of that as a team and then come to the best decision.
Megha Pai: What's important for specialists to know regarding care coordination? When should a referral be made, what follow-up care might be involved, and how can different specialists work together to ensure the best outcomes for patients?
Dr. Adnan Khalif: Essentially, it's as simple as an email or Epic Chat to get a patient referred to us and as simple as having the patient's information provided in that fashion to help facilitate getting the patient on the schedule for a heart team discussion — or referral to the outpatient setting to discuss the best next steps in care for that patient. We ensure that the patient gets presented in a multidisciplinary way to the multidisciplinary team. One of the ways I think AHN is differentiated is our passion for trying to make care accessible to all potential patients.
Megha Pai: What is the recovery process like after an interventional cardiology procedure?
Dr. Adnan Khalif: Because we're a non-surgical option that is minimally invasive, patients typically return home the next day. We even do same-day discharges for many of our procedures. The recovery time is much shorter in patients than it is for open heart surgical interventions. The incisions and catheters that we place usually heal very well.
Megha Pai: What are the long-term outcomes of interventional cardiology procedures?
Dr. Adnan Khalif: Long term, our outcomes are robust and durable. For example, we know that primary angioplasty and stenting have reduced mortality for patients who have heart attacks and are treated promptly. Acute heart attack care has really seen a revolutionary change with interventional cardiology because people who once had mortality rates of 40% to 50% now have survival with these procedures of up to 90%. We know that angioplasty and stenting have minimal risk to patients in terms of mortality, about 1%.
We know that the therapies we provide, from stenting to transcatheter aortic valve replacements, are also durable — in other words, they contribute to longer patient survival. The long-term data for interventional cardiology procedures are pretty well validated, demonstrating safety and efficacy in numerous patient populations. It's really impactful to be able to improve the care of patients with relatively simple procedures.
Megha Pai: What are some challenges you face as an interventional cardiologist?
Dr. Adnan Khalif: Interventional cardiology has been interpreted as being a disruptive specialty, because we try to be as cutting edge as possible. Interventional cardiologists are always looking for new technologies to help facilitate less invasive options for patients. Sometimes we have to overcome the misperception that we are always looking for the next big thing, for a "new toy."
Megha Pai: What are your thoughts on the role of robotics in interventional cardiology?
Dr. Adnan Khalif: Robotics devices have been used in interventional cardiology for a long time. The machine we use to acquire the images while performing an angiogram is robotic and there has been increased use of robotics in percutaneous coronary interventions. Robotic technology can make procedures more accurate and efficient, and I think with continued improvement in technology, we're likely to see increased use of robotics in interventional cardiology.
Megha Pai: What will be the biggest innovations for interventional cardiology in the future?
Dr. Adnan Khalif: The technology game has really improved what we can do and I think that will continue. For example, we started doing transcatheter aortic valve replacements in the last 10 to 15 years, and that's completely changed the treatment of aortic stenosis as a disease. Now we're also seeing that approach in the mitral stenosis space where valve technologies have been implemented to help perform transcatheter mitral valve replacements and tricuspid valve replacements. I think there will be significant innovations in interventional cardiology that offer patients additional options to surgery. We're approaching other treatment modalities for the management of high blood pressure, and we most recently started doing a procedure called renal denervation, a minimally-invasive, catheter-based option to help patients with hypertension. Those are the types of ongoing developments that improve and increase our ability to treat more and more patients with less invasive options.
Adnan Khalif, MD, is an interventional cardiologist and critical care cardiologist with AHN Cardiovascular Institute, focusing on cardiovascular disease, critical care, and interventional cardiology care for patients. He is skilled at coronary and peripheral vascular disease, as well as advanced endovascular and coronary intervention procedures.
Dr. Khalif is core clinical faculty of the General Cardiology Fellowship at the Allegheny General Hospital. In addition, he serves as the Associate Program Director of the Interventional Cardiology Fellowship. He is one of the few physicians in the U.S. to have completed his training in general cardiology, interventional cardiology, and critical care medicine. He was previously the Chief Cardiology Fellow at AHN during his cardiovascular training.
Dr. Khalif went to medical school at University of Medicine and Health Sciences in Basseterre, Saint Kitts. He did his residency at UPMC Mercy Hospital in Pittsburgh, Pennsylvania. He did fellowships in cardiovascular diseases, interventional/structural cardiology, and advanced interventional/critical care cardiology at AHN Allegheny General Hospital in Pittsburgh, Pennsylvania.
Dr. Khalif was inducted to the Alpha Omega Alpha Honor society at Drexel University College of Medicine for his high academic achievement and demonstration of leadership, teaching, and service. He is a clinician-educator whose work primarily focuses on medical education, critical care cardiology and team oriented interventional approaches to complex coronary artery disease, pulmonary embolism, and cardiogenic shock care. His interventional cardiology focus is on complex and high-risk coronary artery disease, as well as advanced endovascular and structural intervention procedures.
Dr. Khalif is certified by the American Board of Internal Medicine, the American Board of Cardiovascular Diseases, and the American Board of Interventional Cardiology.
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